Burnett, Laura-AP 2013-09-06IF -al ECE�W E D
This information is a public record. ForO fftee W 2013
Public Service opportunities are offered by the City Of Coppell without regard J VV
to race. color, national origin, religion. sex or disability. Dat Received.
If you are intcrestcd in applying for more than one position (maximum of thrcc), 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 1 st
choice, #3 being your last choice). Note: Youth Advisors are for students in grades seven through eleven and are not eligible for other
Boards.
ANIMAL SERVICES ADV. & APPEALS CONDUCT REVIEW BOARD
BOARD OF ADJUSTMENT SPECIAL COUNSEL
ECONOMIC DEVELOPMENT COMMITTEE YOUTH ADVISOR -KEEP COPPELL BEAUTIFUL
L KEEP COPPELL BEAUTIFUL YOUTH ADVISOR -LIBRARY BOARD
LIBRARY BOARD YOUTH ADVISOR -PARK & REC BOARD
PLANNING AND ZONING COMMISSION
If asked to serve on a different board than you indicated, would you be interested? (Circle one) e N
Would you be interested in serving on any AD Hoc Committees or Citizen Summits that may arise during the year? (Circle one) (0 N
Would you be interested in serving on any non-profit organization/committee/ task force that may arise during the year? (Circle ones N
PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION CLEARLY
❑ Ms.
a Mrs. L Q LI ra .
❑ Mr. Last Name�t First Name MI
('
l7 ,4r ter Drlyb ( 0D.7E'_.1I1, `r -75-019t i� ) .��y- ��93
Home
Business
Zip Code
Zip Code
Home Phone
0i7,)-)
Business Phone
z5- T110
Resident of City for 17 years? Qualified voter in the City of Coppell? (Circle one) N
If applying for Youth Advisor indicate grade for 2013-2014.
Email Address (required if
;am3o
List any experience that qualifies you to serve in the positions lsought. a- ServeG1 o 0 two
'1D/ol 60'-trd'S EYP I JiOU��/ ��S t� �lr)f /yC�C'�% OoryI m (_t`� 0n �t�0n
Have you ever served as a member of any Coppell boards/commissions/committees? (Circle one) <1 N
If yes, specify which one and the approximate dates of service.
/GUO /C Y
- v2 0
Have you attended one or more meetings of the board/commission for which you have applied? (Circle one)!T) N
List any civic or community activities in which you have been involved.
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1/(� lu nfi e r e� c coloe_/l
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? (Circle one) Y
If yes, please
List your muc tionai nacxgrouna. tc-i 1—o , u - C -w u�
of "?
);a x,17
What is your current place of employment or business affiliation? lease indicate if you are self-employed or
not employed.) -Ir-S
What is your occu ational exp�jrience? Lt rvl FYI��
PLANNIN & ZONING OR BOARD OF ADJUSTMENT APPLICANTS — Please answer the following:
Do you have working knowledge in any of the following areas:
❑ Real Estate/Development ❑ Business Development ❑ Law/Contract Administration
❑ Land Use Concepts and Master Plan ❑ Manufacturing/Industrial Operations
ECONOMIC DEVELOPMENT COMMITTEE APPLICANTS — Please answer the following:
Do you have working knowledge in any of the following areas:
❑ Real Estate/Development ❑ Banking/Finance ❑ Business Management ❑ Promotion/Marketing
❑ Law/Contract Administration ❑ Manufacturing/Industrial Operations
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: i/
S D l.3 tSignature:
�i ln'1
Return to: Boards &Commissions, % Ci y - P. O. Boz 9478, Coppell, TX 75019
Or in person: City Secretary's Office - 255 Parkway Blvd., Coppell, TX 75019
(Deadline for returning application is Friday, September 13, 2013 at 5:00 p.m.)
INTERVIEW SCHEDULE
Board of Adjustment
- Thurs., Oct. 17
Park & Rec. Board Youth
- Mon., Oct. 7
KCB Youth
- Thurs., Oct. 17
Library Board Youth
- Wed., Oct. 9
Animal Services Adv. & Appeals
- Thurs., Oct. 24
Library Board
- Tues., Oct. 15
Planning & Zoning
- Wed., Oct. 30
Economic Development
- Wed., Oct. 16
Keep Coppell Beautiful
- Thurs., Oct.34
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