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CERTIFICATE OF APPLICANT <br />I understand the submission of this application expresses my willingness to accept appointment <br />to the position of municipal judge for the City of Louisville, Colorado, and my willingness to <br />abide by the Louisville City Charter and the Louisville Municipal Code, if appointed. I hereby <br />certify that the information given in this application is correct and complete. <br />Date: <br />Signature of Applicant <br />Print or Type Name <br />WAIVER <br />I grant the City of Louisville, Colorado the right to examine the records of the Attorney <br />Regulation Counsel (formerly maintained by the Supreme Court Grievance Committee) and the <br />records of the Commission on Judicial Discipline. I consent to the release of information by <br />employers, schools, law enforcement agencies, and other authorized personnel to verify the <br />information contained in this application. <br />Date: <br />Signature of Applicant <br />Print or Type Name <br />Applications must be submitted by <br />Page 5 of 5 <br />11 <br />