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Denes, Andrew-AP 2013-08-13This information is a public record. Public Service opportunities are offered by the City Of Ci to race, color, national origin, religion, sex or without regard WED 013 For Pffice Use Only 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/comnalesfor which you are applying (#1 being your ist choice, #3 being your last choice). Note: Youth Advisors are for students in grades seven through eleven and are not eligible for other Boards. AXLMA.L, SERMICES ADV. &. APPEALS BOARD OF ADJUSTMENT ECONOMIC DEVELOPMENT COMMITTEE KEEP COPPELL BEAUTIFUL LIBRARY BOARD PLANNING AND ZONING COMMISSION CONMCT REVIEW BOARD SPECIAL COUNSEL YOUTH ADVISOR -KEEP COPPELL BEAUTIFUL YOUTH ADVISOR -LIBRARY BOARD YOUTH ADVISOR -PARK & REC BOARD If asked to serve on a different board than you indicated, would you be interested.? (Circle one) 4D N Would you be interested in serving on any AD Hoc Committees or Citizen Summits that may arise during the year? (Circle one)Y1 N Would you be interested in serving on any non-profit organization/committee/ task force that may arise during the year? (Circle one)o N PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION CLEARLY ❑ Ms. .�s iUl,.C�E7.1� ❑ Mrs. A Mr. Last Name First Name 3S.4 P��� iC�l/�1�� 7S 9 �01r.4/ Home Address Zip Code Home Phone Business Address Zip Code Business Phone Resident of City for M a years? Qualified voter in the City of Coppell? (Circle one) O N If applying for Youth Advisor indicate grade for 2013-2014. Email Address (required if available) Q Q�PiI -f 6 06W BRQI, , e D h List any experience that qualifies you to sery in the positions sought. v0 / C6 ADyt�r'/S/,lJ� y �Z070 'l���lv�X1,0:, J /•�J A Have you ever served as a member of any Coppell boards/commissions/committees? (Circle one) Y N� If yes, specify which one and the approximate dates of service. Have you attended one or more meetings of the board/commission for which you have applied? (Circle one) Y N List any civic or community activities in which you have been involved. /A?GS Do you have any business or personal relationship with the City of Coppell that would affect your ability t have impartial judgment in City matters? (Circle one) Y If yes, please explain List What is your current place of not employed.) F' - What is your. or business affiliation? (Please indicate if you are self-employed or PLANNING & ZONING OR BOARD OF ADJUSTMENT APPLICANTS — Please answer the following: Do you have working knowledge in any of the following areas: ❑ Real Estate/Development �1 Business Development ❑ Law/Contract Administration ❑ Land Use Concepts and Master Plan ❑ Manufacturinglindustrial 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 p 6lic office or employment as a reward to secure my appointment or confirmation, (help me God." „ Date: eV / 7//.3 Signature: Return to: Boards & Commissions, % City Secretary - P. O. Boz 9AW, 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. 3-4