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City <br />Om <br />of if <br />Louisville <br />COLORADO • SINCE 1878 <br />2012 Application for Ward I <br />City Council Appointment <br />APPLICATIONS DUE TO THE CITY MANAGER'S OFFICE, CITY HALL, 749 MAIN STREET, <br />BY 4 PM ON NOVEMBER 30, 2011. <br />INTERVIEWS ARE SCHEDULED FOR THE EVENING OF WEDNESDAY, DECEMBER 7, 2011. <br />You MUST meet the following criteria to serve as a Ward I City Council member: <br />• You must reside in Ward I and have done so for a minimum of 12 months (see <br />attached map) <br />• You must be a registered elector <br />Name of Applicant: <br />Date of Birth: //4.///9.3 <br />Home Address: <br />Z.).1-84.Ak <br />&./ , /;ie- <br />Louisville CO 80027 <br />Home Phone Number: To 766/, 33 CeII Phone Number: 78?C5 ?JWes- <br />Email Address: <br />e (3•1_ y,47.446e, - <br />Occupation: .eikviJesIC 9/2/4J i <br />Employer: /316 K /2..5 <br />Length of Time Living in Louisville: <br />//:;..7) 7 S <br />STATEMENT OF INTEREST: <br />Please attach a letter or statement briefly describing your interest in serving on the City <br />Council. Feel free to indicate any areas of expertise, background, concerns and /or general <br />information that may be applicable. You may also attach a. resume or other information you feel <br />may be relevant to your application. <br />CURRENTLY SERVING ON A BOARD: <br />Do you currently sit on a City Board or Commission? 0 YES pNO <br />If Yes, please identify that board. <br />S..,.gve -/ w /7j_MIz.1Y9 t 5 /rim <br />It is the policy of the City Council to make appointments to the City Council, citizen boards, <br />commissions, committees, and task forces based on the needs of the City as well as the interests <br />and qualifications of each applicant without discrimination based on race, color, national origin or <br />ancestry, gender, religious convictions, disability, age, or sexual orientation. <br />15 <br />