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Golf Course Advisory Board Application <br />Page 2 of 3 <br />NOTE: You may also attach a letter, resume, statement, or other information you feel may be <br />relevant to your application. <br />CURRENTLY SERVING ON A BOARD: <br />Do you currently sit on a City Board or Commission other than the one for which you are <br />currently applying? I=1 YES NO If Yes, please identify that board. <br />SCHEDULING CONFLICTS: <br />What times Monday through Thursday are you generally unavailable to attend meetings? (The <br />meeting times of each board are available on the City's web site at www.LouisvilleCo.gov.) <br />DISCLOSURES: <br />Within the last ten years, have you ever been convicted of a crime or received a suspended <br />sentence, deferred sentence or deferred prosecution, or forfeited bail, for any offense in <br />criminal or military court, or do you have any criminal charges currently pending against you? <br />Exclude minor traffic violations. E] YES Ed` NO If yes, list for each case: <br />(1) date of offense; (2) charge; (3) jurisdiction; (4) court name and (5) disposition: <br />Within the last ten years, has your driver's license in any state ever been suspended o <br />revoked, or have you ever' been denied a driver's license in any state? ❑ YES al 10 <br />If Yes, please explain below: <br />'.j4 V`?L_Lc ok, aL <br />Have you ever been involved in an incident involving child /elder abuse or child /elder neglect <br />for which a report was filed with or issued by any law enforcement agency or social services <br />agency? ❑ YES L 1 0 If Yes, please explain below: <br />6 <br />City( <br />4- <br />4[ <br />Louisville <br />COLORADO SINCE 1882 <br />