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7[)1 7 i* i) Application <br />Page 3 of 4 <br />DISCLOSURES: <br />LE, City. <br />Louisville <br />Within the last ten years, have youever been convicted of a crime or received a <br />suspended sentence. deferred sentence or deferred prosecution. or forfeited <br />boil, for oily offense in criminal or military court, or do you hove any criminal <br />charges currently pending against you? Exclude minor traffic violal ons. <br />0 YESNO If yes, list for each case: <br />R 1 do a of offense. (2) chane; 13) '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 hove you ever been denied rx driver's License in any <br />state? ❑ YES NO <br />If Yes, please exp ain below: <br />Have you ever been involved in on incident involving child/eider abuse or <br />childlelcier neglect for which a report was tiled with or issued by any law <br />enforcement agency or social services agency? 0 TES IC If Yes, please <br />explain below_ <br />Do you or ca company you work for or own do business with the City of Louisville? <br />0 YES elEr6(2._. 1f Yes, please explain below; <br />• All Committee members serve without compensation. <br />• Anyone applying is subject to a background check. <br />• The City may reject an applicant for any lawful reason. An appointed <br />member may be removed during his/her term of office for cause os defined <br />in the City Charter, Resolution No. 16, Series 21009, and Resolution No. 59, <br />Series 20 16. Reasons for rejection or removal from office include, without <br />limitation, where a background investigation reveals an arrest, conviction, <br />or pending charges for a criminal offense (excluding minor traffic <br />violations). <br />• All information ern This application is public record and may be released for <br />public review. <br />13 <br />