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2020 Board and Commission General Application <br />Page 4 of 4 <br />LCity,/ <br />Louisville <br />COLORADO • SINCE 1878 <br />I understand that I am NOT insured by the City of Louisville Worker's <br />Compensation Insurance and NOT covered by any Accident Medical Insurance <br />Policy while I am a volunteer with the City of Louisville. I authorize that all <br />necessary first aid steps may be taken as prescribed by qualified personnel. <br />I grant full permission to use any photographs, videotapes, recordings or any <br />other record of my volunteer participation as a Board or Commission member. <br />The City will provide any applicant who is rejected as a result of a background <br />investigation information on how to obtain the report and contact information <br />for the reporting agency. Determinations to reject an applicant as a result of the <br />criminal background investigation report are final. <br />BY SIGNING BELOW, I AGREE THAT I UNDERSTAND AND CONSENT TO THE ABOVE <br />STATEMENT: <br />N«��eeee 2) "item- 10/30/2019 <br />Signature Date <br />Additional information: <br />• All applicants must complete this general application AND ALSO submit the <br />supplemental questionnaire for each board to which you are applying. <br />• Not all appointments will require a City Council interview. However, if you are <br />chosen for an interview they are tentatively scheduled for the evenings of <br />December 11 & 12, 5:30 - 10:00 PM. Please be available either in person or by <br />phone. <br />• Please submit your application by email to MeredythM@LouisvilleCO.gov or <br />deliver it to the City Clerk's Office, 749 Main Street. <br />• Questions about a board or about the application process may be directed to <br />Meredyth Muth (MeredythM@LouisvilleCO.gov or 303.335.4536). <br />12 <br />