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2019 Board and Commission General Application <br />Page 2 of 4 <br />• <br />City,f <br />Louisville <br />COLORADO•SINCE S87$ <br />OTHER BOARDS: <br />If asked, would you be interested in serving on a board you did not choose <br />above? 0Yes GNo <br />CURRENTLY SERVING ON A BOARD: <br />Do you currently sit on a City Board or Commission? 0 YES aNO <br />If Yes, please identify that board. <br />SCHEDULING CONFLICTS: <br />What times Monday through Thursday are you generally unavailable to attend <br />meetings? (The meeting times of each board are available on the City's web site <br />at www.LouisvilleCO.gov.) Au A3 )k 1,` t+E` S <br />DISCLOSURES: , <br />Within the last ten years, have you ever been convicted of a crime or received a <br />suspended sentence, deferred sentence or deferred prosecution, or forfeited <br />bail, for any offense in criminal or military court, or do you have any criminal <br />charges currently pending against you? Exclude minor traffic violations. <br />0 YES NO If yes, list for each case: (I) date of offense; (2) charge; (3) <br />jurisdiction; (4) court name and (5) disposition: <br />Within the last ten years, has your driver's license in any state ever been <br />suspended or revoked, or have you ever been denied a driver's license in any <br />state 0 YES ® NO If Yes, please explain below.. <br />Have you ever been involved in an incident involving child/eider abuse or <br />child/elder neglect for which a report was filed with or issued by any law <br />enforcement agency or social services agency? 0 YES ONO If Yes, <br />please explain below. <br />Dou or a company you work for or own do business with the City of Louisville? <br />0 YES CNO If Yes, please explain below: <br />22 <br />