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2019 Ward III City Council Application <br />Page 3 of 4 <br />ism <br />,L Cityof <br />Louisville <br />COLORADO • SINCE -MS <br />I certify that the information in this application is true and complete. I understand that false statements, <br />misrepresentations or omissions of information in this application may result in rejection of this <br />application. The City is expressly authorized to investigate all statements contained in this application <br />and, in connection therewith, to request a criminal history from the Colorado Bureau of Investigation. I <br />consent to the release of information about my ability and fitness by employers, schools, criminal justice <br />agencies, and other individuals and organizations to investigators, personnel staffing specialists, and <br />other authorized employees of the City of Louisville, and release all parties for all liability for any damage <br />that may result from furnishing such information. <br />In the event that I am selected to serve on the City Council, I agree to comply with all of its ordinances, <br />rules, and regulations. <br />I grant full permission to use any photographs, videotapes, recordings or any other record of my <br />participation as a City Council member. <br />The City will provide any applicant who is rejected as a result of a background investigation information <br />on how to obtain the report and contact information for the reporting agency. Determinations to reject an <br />applicant as a result of the criminal background investigation report are final_ <br />BY SIGNING BELOW, I AGREE THAT I UNDERSTAND AND CONSENT TO THE ABOVE <br />STATEMENT: <br />Signature <br />Date r2, /9/ I 9- <br />5 <br />