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Janice Ellis <br />From: support@civicplus.com <br />Sent: Friday, May 06, 2011 3:57 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 />The Paris City Council is sesking committed individuals who are dedicatect to tl1e wet!-being of the Paris community to serve on its <br />standing boarcis, commissions, and committees. In general, it is me efty coWnaf's paky to appoint persons to a maximum of two <br />consecutive futl three-year terms on a given body. In addition to the general quaNcaWns llstetl in the certification below, other <br />qualifications may be mandated by statute, City Charter, ordinance, or resolutIon. PEease complete the information reqaested betow. <br />Fiest Name' ~ame$ Last Br'OCkway <br />Name' <br />Address* 3350 Robin Rd. <br />City' Paris State' TX Zip` (X) 75480 75462 <br />75461 <br />Telephone <br />(903)123-4567` <br />Areas of Interest* <br />Please note any special knawledge, education, or <br />experience you have that is spplicable to the function <br />of the board, Commission, or committee of interest <br />(attach additionai pages if necessary). If applicable, <br />list dates of service on any City boards, <br />commissions, or committees. <br />Certiflcation and Auttwrization <br />903-737-8833 <br />( j Airport Advisory BoeFd <br />( I Municipal Bartd Ccxnmiss+on <br />Building & Standards Cor►mission <br />[ I Paris/Lamar Counry Boanf oi <br />I J Civil Service CoFnmission <br />IXI Eeonomic Development <br />HooM <br />I I Pfanning & Zoning ComrMsskm <br />Corporation <br />Publfe Library Advisory Board <br />[ J Historic Preservation Commissian <br />[ J Tratfic Commission <br />[ l Zoning Baard of Adjustment <br />( I Housing Authority Board of <br />Commissioners <br />[ ] 5treet Advfsory Board <br />I'm currontly servMg on Mein St. Advisory Board and woutd like ta beeome <br />more involved in our city. <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 Texas regarding <br />nepotism and canflicts af interest of appointees to City boards, commiasions, and commlttees. I aiso certify Mat if appoir►►teci 1 wi# <br />attend at lea&t 75 percent of all regular meetings and shali not have any delinquent indebtedness to the City during my term. I <br />understand that the number of positions on a given board, commission, or cammittee Is limited arui that I may rtot be appoPnted; <br />however, if I am not appoirrted, I agree to be placed in a database for possible Tuture notHicafion of topics of interest. I certify that the <br />information given by me In this application is true and correct and any false inEarmation or misrepnesentation is sufficient grounds for <br />disquatification. I authorize the City of Paris to verify afl infortnation provided In thia appNcation. In accordance with Secfion 552 af the <br />Locat Govemment Code, 1 understand that information provided in this apptication may be avaitabie to the pubiic upon request.` <br />[X] Agree <br />` indicates required fields. <br />[ ] Disagree <br />The following fortn was submitted via your website: Application for Boards / Committee / Commission <br />168 <br />