Davis, Garry-AP 2013-09-10RID EcrIVED
This information is a public record. For MFe jTs@ M1J
Public Service opportunities are offered by the City Of Coppell without regard
to race, color, national origin, relizion, sex or disability. I Date I0 ti%e&etarV
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 for students in grades seven through eleven and are not eligible for other
Boards.
ANIMAL SERVICES ADV. & APPEALS
BOARD OF ADJUSTMENT
ECONOMIC DEVELOPMENT COMMITTEE
KEEP COPPELL BEAUTIFUL
LIBRARY BOARD
PLANNING AND ZONING COMMISSION
CONDUCT 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) Y N
Would you be interested in serving on any AD Hoc Committees or Citizen Summits that may arise during the year? (Circle one) Y N
Would you be interested in serving on any non-profit organization/committee/ task force that may arise during the year? (Circle one) Y N
❑ Ms.
PMrs.
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PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION CLEARLY
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Last Name
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Home Address
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First Name
Zip ode
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Zip Code
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Home Phone
(IL� 64-1F�r
Business Phone
Resident of City for ( years? Qualified voter in the City of Coppell? (Circle one N
If applying for Youth Advisor indicate grade for 2013-201I14.
C,\,- r C-1Email Address (required if available) C1 1 0)_ `1l a �° ".
List any experience that qualifies you to serve in'the positions sought.
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Have you ever served as a member of any Coppell boards/commissions/committees? (Circle one) Y
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 Q�)
List a y civic or community activities in which you have been involved. S c"o L_A_ J" T G/
Do you have ao business or personal relationship with the City of Coppell that would affect your ability to
have impartial judgment in City matters? (Circle one) Y S
If yes, please explain
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List your educational background. " v \ V� L,, S I ( )cc- - l
What is your current pl ce of employment or business affiliation? (Please indicate if you are self-employed or
not employed.) - S"Lo LIt-A- ( u , -V, _
What is your occupational experience?
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 ❑ 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.
NOTE: APPLICATION MUST BE SIGNED BELONN' BY APPLICANT..
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 ublic office or employment as a reward to secure
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my appointment or confirmation o help me'
Date: 1,14 YJ Signature:
Return to: Boards & Commissions, % City Secretary - P. O. Box 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. 31