Loading...
Adamson Grace- AP 2011-08-31RECEIVED This information is a public record. For Office Use Only Public Service opportunities are offered by the City Of Coppell without regard SEP 2 2011 to race, color, national origin, religion, sex or disability. Date Received CITY SECRETARY If you are interested in applying for more than one position (maximum of three), please indicate the order of your preference by placing a number in the space to the left of the board/commission/committee for which you are applying (#1 being your 1st choice, #3 being your last choice) Note: Youth Advisors are not eligible for other Boards. If a board has more than 25 applicants, interviews will only be granted to those who have chosen that particular board as their first choice. Please note that choosing more than one board increases the chances of being appointed. "IMALSERVICES ADVISORY & APPEALS PLANNING AND ZONING COMMISSION BOARD OF ADJUSTMENT SPECIAL COUNSEL CONDUCT REVIEW BOARD YOUTH ADVISOR -KEEP COPPELL BEAUTIFUL COPPELL ECONOMIC DEV COMMITTEE YOUTH ADVISOR -LIBRARY BOARD KEEP COPPELL BEAUTIFUL BOARD YOUTH ADVISOR -PARKS & REC BOARD LIBRARY BOARD ff asked to serve on a different board than you indicated, would you be interested? (Circle one)Yes No Would you be interested in serving on any AD Hoc Committees or Citizen Summits that may arise dunng a year? (Circle one) Yes No PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION CLEARLYIN BUCK INK ONLY. ❑ Ms. /1 Mrs. Prc karnso f1 lv 1►f'aC- E_ ❑ Mr. Last Name \ First Name MI 00 CckCr1 aG e. C -. 750t9 c �gs3 -ga�8. Home Address Zip Code Home Phone Business Address Zip Code Business Phone Resident of City for 4 + years Qualified Voter? XYEs ❑ NO (MUST BE REGISTERED TO VOTE IN THE CITY OF COPPELL) If applying for Youth Advisor indicate grade for 2011-2012 Email Address (required if available) Old ajn_<, 8 C-Ia 4-e Far M. C6 &-) List any experience that qualifies you to serve in the positions sought. ?rp`e& k'�'larlgo,e� f 'Prue - [���` h 0.�oC' ��► irt� � �.V � �/ Lri � � �t tY� C.Q ©01 �! h � r � �� V-e.,t-' Have you ever served as a member of any Coppell boards/commissions/committees? Yes ❑ No If yes, specify which one and the approximate dates of service. M1 f�- List any civic or community activities in which you have been involved. G U -M 0r+' C-012120 (continued on back) Do you have any business or personal relationship with the City of Coppell that would affect your ability to have impartial judgment in City matters? If yes, please explain. List your educational background. ops e,� %C,1a:mrL, ,4,, )Sun r, t. -r> ❑ YES NO What is your current place of employment or business affiliation? (Please indicate if you are self- employed, a Homemaker, or not employed.) GAr c.o �' �- ,� �0,.1C-L, ZZ Yrs What is your occupational experience? c , r � C-00catr.A This application is the only information considered for appointments by the City Council. Please do not send resumes, business cards, photographs or letters of recommendation. Please call (972)304-7016 for more information about the City's boards, commissions and committees. STATEMENT OF INTENT: "If appointed, I agree to serve on the Board/Commission for which I have applied. I do solemnly swear (or affirm), that I have not directly or indirectly paid, offered, promised to pay, contributed, or promised to contribute any money or thing of value, or promised any public office or employment as a reward to secure my appointment or confirmation, so help me God." Date: _$� 3C Ir 111 Signature: , �o-C� Return to: Boards & Commissions, % City Secretary - P. O. Boz 9478, Coppell, TX 75019 Or in person: City Secretary's Office - 255 Parkway Blvd., Coppell 75019 (DEADLINE FOR RETURNING APPLICATION IS SEPTEMBER 23, 2011 at 5:00 p.m.) FAX COPIES WILL NOT BE ACCEPTED! The interview schedule is as follows and will be conducted in the evein s. There will be no makeu times. If ou will not be available for the interview, you may wish to consider another board. Incumbents are not required to re -interview but are stronaly encouraged to do so You will receive a letter prior to the interview schedulma your interview time for the appropriate date Animal Services Advisory & Appeals - Tues., Oct 18 Library Board - Tues., Oct. 18 Board of Adjustment Conduct Review - Mon., Oct. 17 Library Board Youth Ad. - Thurs., Oct. 6 Economic Development - Thurs., Oct 20 - Wed., Oct. 19 Park & Rec. Youth Ad. Planning & Zoning - Tues., Oct. 4 Keep Coppell Beautiful - Wed., Oct. 5 Special Counsel -Thurs., Oct. 6 - Thurs., Oct 20 KCB Youth Ad. - Thurs., Oct. 20 ►,I