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2018 Board and Commission General Application <br />Page2of4 <br />L <br />Cit �,t Louisville <br />INCE 1.876 <br />OTHER BOARDS: <br />If asked, would you be interested in serving on a board you did not choose <br />above? ® Yes 0 No <br />CURRENTLY SERVING ON A BOARD: <br />Do you currently sit on a City Board or Commission? OYES 0 NO <br />If Yes, please identify that board. <br />SCHEDULING CONFLICTS: <br />What times Monday through Thursday are you generally unavailable to attend <br />meetings? (The meeting times of each board are available on the City's web site <br />at www.LouisvilleCO.gov.) <br />Thursday and Friday evenings <br />DISCLOSURES: <br />Within the last ten years, have you ever been convicted of a crime or received a <br />suspended sentence, deferred sentence or deferred prosecution, or forfeited <br />bail, for any offense in criminal or military court, or do you have any criminal <br />charges currently pending against you? Exclude minor traffic violations. <br />OYES 0 NO If yes, list for each case: (1) date of offense; (2) charge; (3) <br />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 have you ever been denied a driver's license in any <br />state 0 YES ® NO If Yes, please explain below: <br />Have you ever been involved in an incident involving child/elder abuse or <br />child/elder neglect for which a report was filed with or issued by any law <br />enforcement agency or social services agency? 0 YES ® NO If Yes, <br />please explain below: <br />Do you or a company you work for or own do business with the City of Louisville? <br />0 YES ONO If Yes, please explain below: <br />11 <br />