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It is the City Council’s goal to maintain a balance of membership on its
Boards/Commissions/Committees based on race, gender and Council Ward residency.
Has any formal charge of professional misconduct, criminal misdemeanor or felony ever been
filed against you in any jurisdiction?
Is there any conflict of interest or other matter that would create problems or prevent you from
fairly and impartially discharging your duties as a appointee of the City Council?
I understand this application is public record and I certify that the facts contained in this application are true and correct to the best of
my knowledge. I authorize and consent to background checks and to the investigation and verification of all statements contained
herein as deemed appropriate. I further authorize all information concerning my qualifications to be investigated and release all
parties from all liability for any damages that may result from this investigation. I understand and agree that any misstatement may be
cause for my removal from any Board/Commission/ Committee. I understand regular attendance to any
Board/Commission/Committee is important and, accordingly, I further understand that if my attendance is less then the standards
established for any such body that this is cause for removal. Lacking any written standards for attendance by any
Board/Commission/Committee it is expected that I will attend at least 75% of all meetings during any one calendar year to maintain
my seat on any Board/Commission/Committee to which I may be appointed. This form will remain on file in the Office of the City
Clerk and requests for updates will be sought prior to any consideration for reappointment (or future appointment) to any
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