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Janice Ellis <br />From: support@civicplus.com <br />Sent: Wednesday, May 11, 2011 9:57 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 / Committee / Commission <br />FIl`St NalRe" <br />T W <br />AddreW <br />kfao-€w ` <br />City* <br />P" StOW 1`iC ?.lp* (X) 4460 ()75462 <br />( ) r4464 <br />Telephone <br />903.784.4001 <br />(903) 1234W7" <br />( T- Akpot Acykoy Bowd Pq Munhcipe! Barrid CMMission ; <br />Areas of In * <br />Buifft,& SWWards Cmvygssdf~~ 11 ~ bt <br />C I Ciw service comm <br />~ <br />GQt°~tMic~n <br />PI~'ting 8~ <br />E~i~ m~tt ~ <br />~c L. A~~r ~r~f <br />t I H~ Presenration Ccunniissim I I Traft ssior <br />pq Zan#n9 Board a1' Adjustment <br />[ } , Houeft: iy Board a# <br />Ccur►m rem <br />[ ] Streef AdvMry Boart! <br />Please note any special fsnovvkedge, education, or <br />Since retirament frorn Paris !S?, work with a nt.mber of crganizatians vAth <br />experience you [ave that Is apEp€icable t€a the function <br />oatline (htternet) datg"e appt Qtgertizeitons inctudaUSDE.A (kJnited <br />of the boarcd, cornmissiAn, srr commtttee o# intefest <br />States Distarcs Learrdng AsSr►), tJniv. of Cobrado, UTw"TeteCampus, <br />(attach additional pages ifi necessary). Ifi appticable, <br />V1tCET(Westem Ccuopetattve 1or Educationat Tet+er.,ommurt ' etc.. alsa <br />tist dates of service on any City baards, <br />cumently am an adjuncf insEWor at FJC. Resume (not e;pclateci s'rnr.e ! retired <br />commissiors, or committees. <br />in 2006) can ke viewed at: hltEa:th~.conconned.notJBCt?-Bennie <br />Tschoemee.ptif' Idf?TE: ihe URL above is listed since t sawr rro way fo R7TACH <br />addifional pages!!!???t! <br />Certificatian and Au#harizzation <br />I acknowledge that I am aware and agree to the prohibitions a# the City of Paris Chacter and ths Caws o#`the Stae of Texas regatdirig <br />nepotism and canflicts of inte(est of appointees ta City boarc#s, comm"ons, and cortntittees, l a1so cartify that if appointed ! vin <br />attend at least 75 percent of aH regular meefings and shali not have any cMaEinquerv# indebtedness to the C'tfiy during my terrn. 1 <br />understand that the numiber of posi#ions cm a given baard, comrr"or►, or committee is tiryuited arxi that 1 may nctt ba atppoirtied, <br />however, if t am not appointed, I agree to be ptaced rn a database #or poiWble fubute nod#ic.ation of topics of interest. 1 Ce" ftt the <br />information given by me in this application is true and corrsct and arty fa4se intormatbn or misrepresenEa#fon is sufkWnt grounds#ar <br />disqualifica6lon, t auihorize the Cityy of Paris to verify alt infarrnatiort providact in tttis app#ication. fn aceordarce wfth Secticn 552 of the <br />Local Goventment Code, ! ur►derstand that intormation providecf in this apptication may be available to the pub0e uport reqttesf. <br />[X] Agree <br />" indicates required fields. <br />[ ] Disagree <br />- 1 22~ <br />