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Janice Ellis <br />From: support@civicplus.com <br />Sent: Wednesday, May 11, 2011 3:22 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online 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 I Committee / Commission <br />The Paris City Councii is seeking committed individuais who are dedicated to the weN-being of the Paris community to serve on its <br />standing boards, commissions, and committees. In generat, it is the City Council's policy to appoint persons to a maximum of twa <br />consecutive fuil three-year tertns on a given body. In addition to the general qualiflcations listed in the certification betow, other <br />qualifications may be mandated by statute, City Charter, ord'mance, or resolution. Pteasa eomplete the information requested below. <br />First Name ` john Last PENDLETON <br />Name* <br />Address` 475 SE 31 st <br />City" Paris State` TX Zip" (X) 75460 75462 <br />75461 <br />Telephone <br />(903) 123-4567' <br />Areas of interest" <br />Please note any special knowledge, education, or <br />experience you have that is applicable to the function <br />of the board, commission, or committee of interest <br />(attach additional pages if necessary). If appiicable, <br />list dates of service on any City boards, commissions, <br />or committees. <br />Certification and Authorization <br />903 784 5832 <br />[ ] Airport Advisory Board <br />[ j Buitding & Standards <br />Commission <br />[ ) Civil Seroice Commission <br />[ ] Economic Development <br />Corporation <br />[XJ Hiskaric Preservation Cammission <br />[X] Housing Authority Board of <br />Commissioners <br />[ ] Street Advisory Board <br />[ J Municipal Bend Commission <br />[ ] ParislLamar County Board of <br />Health <br />[X] Planning & Zoning Commission <br />[X] Pubiic Library Advisory Board <br />[ ] Traffic Commission <br />[ ) Zoning Board of Ad}ustment <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 Tex,as regarding <br />nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed 1 wiit <br />attend at least 75 percent of all regutar meetings and shall not have any de{inquent indebtedness to the City during my tertn. ! <br />understand that the number of positions on a given board, commission, or committee is lim9ted and that 1 may not be appointed; <br />however, if I am not appointed, I agree to be plaeed in a database for passible future notification 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. 1 authorize the City of Paris to verity all Information provided in this application. fn accordance wiih 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 <br />' indicates required fields. <br />[ ] Disagree <br />The following fonn was submitted via your website: .Application for Boards / Committee / Commission <br />i <br />110 <br />