10-Appointing Member to the Various Boards

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BOARD/COMMISSION/COIVIMITTEE APPLICATION The Paris City Council is seeking committed individuals who are dedicated to tlle well-being of the Paris community to serve on its standing boards, commissions, and committees. In general, it is the City Council's policy to appoint persons to a maximum of two consecutive full three-year terms on a given body. In addition to the general qualifications listed in the certification below, other qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas, 75461. Board/Commission/Committee of lnterest ❑ Aitport Advisory Board ❑ Building & Standards Commission ❑ Civil Service Commission ❑ Economic Development Corporation ❑ Historic Preservation Commission ❑ Housing Authority Board of Commissioners ❑ Main Street Advisory Board Candidate Information ❑ Municipa] Band Commission ❑ Paris/Lamar County Board of Health ~ Planning & Zoning Commission ❑ Public Library Advisory Board ❑ Traffic Commission Zoning Board of Adjustment Name: Address: X//I7 Z6"CG_s_,t C 71- Work Phone: 7C% Home Phone: 2 C~ 7 fS5~~/ 3 Fax: E-mail Address: Please note any special knowledge, education, or experience you have that is applicable to the function of the board, commission, or committee of interest (attach additional pages if necessary). If applicable, list dates of service on any City boards, commissions, or committees. Certification and Authorization By signing below, 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 nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed 1 will attend at Ieast 75 percent of all regular meetings and shall not have any delinquent indebtedness to the City during my tenn. I understand that the number of positions on a given board, conunission, or committee is limited aiid that I may not be appointed; however, if ] am not appointed, I agree to be placed in a database for possible future notification of topics of interest. I certify tliat the inforniation given by me in this application is true and correct and any false information or misrepresentat' ~ sufficient grounds for disqualification. 1 authorize the City of Paris to verify all information provided in this applicat' n. In accordance with Section 552 of the Local Government Code, I understand that information provided in this a licat' ay be available to tb y@-1*$c upon reyWst., Signature of Candidate: Date:_Z Conflict of Interest: Y i N Indebtedness: Y` N Nepotism: Y i N Dist.: 1 2 3 4 5 6 7 Previous Serrice: 0 1 2 3 4 5 h City of Paris MAY 12 2011 Revised 02/19/08 _ ~ n R