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Portman, Glenn-AP 2013-08-16This information is a public record. F e firy V C q 16 313 Public Service opportunities are offered by the City Of Coppell without regard to race, color, national origin, religion, sex or disability. DIte Rec 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 (#I being your I 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 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 Y N If asked to serve on a different board than you indicated, would you be interested? (Circle one) C 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/committeel task force that may arise during the year? (Circle one) Y N PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION CLEARLY El Ms. 9�> ElMrs. rIt 01- q #4. Mr. `Last Name FTia Name 1"1Q fo r CIL C_ (9'1�) 30y, Home Address Zip Code Home Phone rr e --t,- f -t X133 (D JAct L. 40 ci Business Address Zip Code Business Phone Resident of City for 7 years? Qualified voter in the City of Coppell? (Circle one) (Z) N If applying for Youth Advisor indicate grade for 2013-2014. Email Address (required if available) C\t'tA(\A PO Ar'^AA Q,+'p List any experience that qualifies you to serve in the positions sought. Cr-ese,,+J(4 seri: ^q o.\ f-llqirt n.k n5 Have you ever served as a member of any Coppell boards/commissions/committees? (Circle one) (2) N If yes, specify which one and the approximate dates of service. P1QAA,'A4 4 U"'- '40 ze.- C 1 Cb061-.;.&t Ja 17, Have you attended one or more meetings of the board/commission for which you have applied? (Circle one) fv I N List any civic or community activities in which you have been involved. Sae- e -_k. 4: f 13- et'#,C'S-44 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 explain. List your educational background. Whatis your current place of employment or business affiliation? (Please indicate if you are self-employed or not employed.) e VTo-t,,,er, P. C, OF 6x�jiei A6,,^e-Q What is your occupational experience? &-e q U(ts 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 E2/Business Development areas: Administration 12""Land Use Concepts and Master Plan �2/manufacturing/lndustrial Operations ECONOMIC DEVELOPMENT COMMITTEE APPLICANTS — Please answer the following: Do you have working knowledge in any of the following areas: El Real Estate/Development El Banking/Finance 0 Business Management El Promotion/Marketing El Law/Contract Administration D 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:s 11b U Pr I 3 Signature: V V 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