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Janice Ellis <br />From: support@civicplus.com <br />Sent: Tuesday, June 08, 2010 1:45 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Oniine Form Submittal: Application for Boards/Committee/Commission <br />If you are having problems viewing this HTML email, click to view a Text version. <br />Application for Boards/Committee/Commission <br />The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to serve on its <br />standing boards, commissions, and committees. In general, it is the City Council's policy to appoint persons to a maximum of two <br />consecutive full three-year terms on a given body. In addition to the general qualifications listed in the certification below, other <br />qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested below <br />First Namei <br />douglas Last wehrman <br />Name' <br />Address' <br />1050 wilbum <br />City' <br />Paris State' TX Zip* (X) 75460 75462 <br />75461 <br />Telephone <br />903-785-1837 <br />(903) 123-4567' <br />Airport Advisory Board Municipal Band Commission <br />Areas of Interest" <br />Building & Standards Commission Paris/Lamar County Board of <br />[ ] Civil Service Commission Health <br />[X] Economic Development Planning & Zoning Commission <br />Corporation [ J Public Library Advisory Board <br />[ j Historic Preservation Commission I l Traffic Commission <br />Housing Authority Board of Zoning Board of Adjustment <br />Commissioners <br />[ J Street Advisory Board <br />Please note any special knowledge, educatian, or <br />Owened and operated a successful physical therapy clinic for over 35 years. <br />experience you have that is applicable to the <br />Formed first and only successful joint venture between iwo competitive <br />function of the board, commission, or committee of <br />hospitals. Very ac6ve in developement of programs for children in atheletics. <br />interest (attach additional pages if necessary). If <br />Very active in community activities, church, industry artd medicine. Resume <br />applicable, list dates of service on any City boards, <br />available if desired. My passion has been with Paris since I moved here in 1975 <br />commissions, or committees. <br />and Paris has been very good to me and my family. I want to keep jobs in Paris <br />and work hard to bring further employment to our community. I know I have the <br />skills to make this happen and I'm willing to go the extra effort for Paris's <br />success. <br />Certification and Authorization <br />I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the State of Texas regarding <br />nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed I will <br />attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness to the City during my term. I <br />understand that the number of positions on a given board, commission, or committee is limited and that I may not be appointed; <br />however, if I am not appointed, I agree to be placed in a database for possible future notifica6on of topics of interest. I certify that the <br />information given by me in this application is true and correct and any false information or misrepresentation is sufficient grounds for <br />disqualification. I authorize the City of Paris to verify all infoRnation provided in this application. In accordance with Section 552 of the <br />Local Govemment Code, I understand that information provided in this application may be available to the public upon request.` <br />[X] Agree [ ] Disagree <br />* indicates required fields. <br />i <br />iG~ <br />