10-Appointing Member to the Various Boards

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BOARD/COM1`v1ISSiON/COMMITTEE APPLICATION The Paris City Cowlcil is seeking committed individuals who are dedicated to the Nvell-being of the Paris coinmunity to serve on its standing boards; commissions, and committees. In genei-al, it is the City Council's policy to appoint persons to a maximum of two consecutive full three-year tern7s on aoiven body. In addition to the general qualifications listed in the cErtification below, other qualifications nlay be illalidated by statute, City Cliarter, 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 Interest ❑ Airport Advisory Board ❑ Building & Standards Commission ❑ Civil Service Commission ❑ Economic Development Corporation ❑ Historic Preservation Commission ❑ Housing Authority Board of Commissioners ~ Main Street Advisory Board tandidate IRformation . Name: Address: ~ ❑ Municipal Band Commission ❑ Paris/Lamar County Board of Healtli ❑ Planning & Zoning Commission ❑ Public Library Advisory Board ❑ Traffic Commission ❑ Zoning Board of Adjustment Work Phone: Home Phone: -!~_l 7- qo5:;?, Fax: E-mail Address: ~ r~ Gb A 6,nAe a-Ir~ c 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 By signing below, I acknowledge that ] 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 I will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness to the City during my term. I understand that the number of positions on a given board, commission, or committee is limited and that 1 may not be appointed; however, if I am not appointed, I agree to be placed in a database for possible future notification of topics of interest. 1 certify that the information given by me in this application is tnie and coirect and any false information or misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify all information provided in this application. In accordance with Section 5 of the Local Government Code, 1 understand that information provided in this app icat n may be av e t u o request. Signature of Candidate: ~ Date: For Citv Clerk's Use Onlv Conflict of Interest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: ] 2 3 4 5 6 7 Previous Service: 0 12 3 4 5 6 City of Paris Revised 08/19/08 86 Certification and Authorization