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Janice Ellis <br />From: support@civicplus.com <br />Sent: Tuesday, February 01, 2011 8:50 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online Form Submittal: Application for Boards / Committee / Commission <br />If you are having problems viewing t]lis 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 tFie Paris communityy to serve on its <br />standing baards, comrnissions, and committees. In general, it is the City Council's palicy ta appoint persons to a maxfmum of two <br />consecutive fuli three-year terms on a given body. In addition to the general Gualifications listed in the certification betow, other <br />quafifications may be mandated by statute, City Charter, ordlnance, ar resolutlan. Pfease complete the infortnation roquested betow. <br />First Name* Arjumand Last Fiashmi <br />Name* <br />Address' 3220 Abby Lane <br />City' Paris State' TX Zip' 75460 (X) 75462 <br />( ? 75461 <br />Telephone <br />(903) 123-4567" <br />Areas of Intere,sY <br />Please note any speeial knowledge, education, or <br />experience yau have that is applicabte to the <br />function of the boaPd, commission, or committee of <br />interest (attach additiona{ pages if necessary). If <br />applicable, list dates of service on any City boards, <br />commissions, or committees. <br />Certification and Auihodzation <br />903 783 1598 <br />[ ) Airport Advtsory Board <br />[ j Building & Standards Comrreission <br />[ ] Civil Service Commission <br />[X] Economic Development <br />Corporation <br />[ J Historic Presarvation Commission <br />[ ) Housing Authority Board of <br />Commissioners <br />[ J Street Advisory Board <br />( ] Municipal Bar►d CorrrmissEon <br />[X] Paris/lamar County Board af <br />Health <br />[ ] Planning & Zoning Commission <br />[ ] Pubtic Library Acfviscuy Board <br />I l Tratfic Commissicrn <br />[ j Zoning Board of Adjustment <br />1 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 confiicts of interest of appointees to City boards, commissions, and committees. f also certity that if 8ppointed 1 will <br />attend at least 75 percent of all regular meetings and shatl not have any delinquent indebtedness to the Cityy during my term. I <br />understand that tfie number of positions on a given board, commission, or committee is limfted and that I may not be appanted; <br />however, if I am not appointed, I agree to be placed in a dahabase for possrble fature notlflcatiort of topics of interest. I eertity that the <br />information given by me ir► this application is tn.ie and correct and any false information or misrrepresentaton is sufflcienf grournds f+or <br />disqualification. I authorize the City of Paris to verify all infortnation pcovided fn this application. In accordance with Section 552 of the <br />Local Govemment Code, I understand that information provided in this application may be avaifable to the publlc upon request." <br />[X] Agree [ j Disagree <br />" indicates required fields <br />1 <br />94 <br />