HomeMy WebLinkAboutItem 07 - HPC AppointmentsCITY OF GRAPEVINE
E30ARD AND COMMISSION APPLICATION
BOARD OR COMMISSION:
Use a separate application for gkch appointment desired
Name: Ms. Mrs. Dr.
Address:
Cell phone: 617. 366, I Work phone:
Employer:4)411111��-
Occupation:
Grapevine Resident 3, <_)Years
E-mail Address:
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Tarrant Co. Voter Registration No._101 6 8`7qE
Why are you interested in being appointed to this board/commissi ?
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any City service and experiprice
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What is your educational and qccupational ex erience7
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What other knowledge, experience, or education d you ��ave that is applicable to th'."1r6_/ o soplio.
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What do you believe will be y 9nificant cpptribution t th b J1 n?
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What else would you like to tell us about yourself?
List the name and phone number of one Grapevine resident, City staff, City Council, of current
Committee member , ha may be contacted on yo.ur behalf.
Number of Board/Commission meetings attended in past 12 months
Number of City Council meetings attended in past 12 months
Have you ever entered a guilty plea or no contest or been convicted of a crime in a civilian or
military court or received a deferred adjudication (not including traffic violations)?
If yes to the above question, what offense(s) and counties/states/dates? If this is not applicable,
type "NA". (A criminal record will not necessarily disqualify you from appointment).
I understand that by signing this application my attendance will be required at all
committee meetings.
Signature:
Date:
*** In order to allow greater participation in the City government, board appointments are limited
to one member per household. Spouses will not be appointed to serve on boards, either the
same board or a different board.
Please return completed application to the City Secretary's Office;
By mail: PO Box 95104, Grapevine TX 76099
By fax: 817-410-3004 1 By email: lifimbres@grapevinetexas.gov