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HomeMy WebLinkAbout2008-04-01 Appointment~~ V NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: CIVIL SERVICE COMMISSION One Vacancy -Four-yr Term April 7, 2008 -April 2, 2012 Duties: Approve all entrance and promotional examinations used by the City of Iowa City; holds hearings involving employee discharge or reduction in rank or compensation and ascertains to the best of its ability the facts of the case. After weighing all evidence, takes action as provided in Chapter 400 of the Code of Iowa. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. Members of the Civil Service Commission must be residents of the City of Iowa City preceding their appointment. The Commission meets when deemed necessary. Applications must be received by 5:00 p.m., Wednesday, March 5, 2008. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Civil Service Commission should be directed to Sylvia Mejia, Personnel Administrator at 356-5026. ~. ~~F~`'`-r~i m -t z0 3 m O X II 11 II 11 II ZZDD'~ ~ ~ tAa y ~ ~'~~~~ 3~rn~~ ~ ~ A C ~ ~ fl. ~ o `~ D _ n ° v m °o ~ ~' ~ 3 ~ c~ o ~ x ~ - v ~ ~ ~ ~ 3 ~ ~ ~;, m N 0 co 0 00 0 0 w X X >C o 0 Q7 x x x N 0 0 V OD x x x W o N 0 0 D rn T ~ Z D D 7 ~ ~ ~ IV I'1'1 ~ O ~ ~ ~m v 00 0 sv a n O 3 3 N!~ N n <~ ~D n 0 3 3 y~ _N O~ Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 1 Council Announcement Date: January 29, 2008 Application Deadline: Wednesday, 5:00 p.m., March 5, 2008 Council Appointment Date: March 11, 2008 CIVIL SERVICE COMMISSION One Vacancy -Four-Year Term April 7, 2008 -April 2, 2012 Term expires for Dorothy Maher Dorothy Maher ~ (Currently serving 1St four-year term) 836 West Side Dr ~ Denotes applicant completed the Confidential page of the application. City of Iowa City ~ r 1 ~~®~ Advisory Board/Commission/Committee ~' ~"'~~~ :' pplication Form -^~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF}. Retum the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. .Advisory Board/Commission/Committee Name Civil Service Commission i berm X08-2012 :i Youth Advisory Commission, Age on the date of filing:Q Age 15 to 17 (or) Age 18~q 21-~y -. Signature of parent/guardian if Age 15 to 17: - - - `~? - _.~ NgME Dorothy M. Maher HOME ADDRESS 836 West Side Drive Iowa City, IA 52246 _ ~, ZIP 52246 Is your home address (listed above) within the corporate limits of Iowa City? ~/ Yes How long have you been a resident of Iowa City? lifetime No OCCUPATION Attomey EMPLOYER Retired University of Iowa PHONE NUMBER: HOME (319) 351-2784 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: My work experiences as Assistant County Attorney, private practitioner and University Associate Counsel have provided me the opportunity to work with a variety of staff and clients on a broad spectrum of issues involving criminal, civil and administrative law--including acting as a hearing officer in student disciplinary complaint proceedings. These positions have allowed me to develop the abilities that qualify me for this Commission--to conduct proceedings, review evidence and render opinions. In addition, I have been a member of this Commission for the term 2004-2008 and have enjoyed the experience. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. general Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? As a member of the Civil Service Commission for the past four years, I am familiar with the purpose, function and ~~ ~-~sdiction of the Commission, Chapter 400 and Section 362.5 of the Code of Iowa and have participated in various wrings and deliberations. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As a result of my professional and personal life experiences, 1 believe. I have developed the ability to listen, to assess, to review facts in evidence and to render just and fairconclusions--skills that have proven valuable to this Commission and will continue to offer value to the community at large. _,, _. _ __ _ - -~ 1 - ;~,~ -~_ - - -- _, .t ,, _-, - , =:= 1 ~. ~ - - POTENTIAL CONFLICTS OF INTEREST ``': Please identify any- potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. ' articular, if you are applying to be a member of a board or commission which makes recommendations tothe (,~iy Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attomey's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~/ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of 7 ~ r 1 ~_..®~ BOARD, COMMISSION AND COMMITTEES ~ ,~`1°,~~~ BUSINESS LISTING .,.t,,s,_ CITY OF IOWA CITY Name of City Board/Commission/Committee Civil Service Commission Date 02/21/2008 Name Dorothy M. Maher Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spousefdomestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Tease indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Macht very minority shareholder 19 1/2 Dubuque St Iowa City IA ~.~ ( '1 _._7 \-:.r NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additions( business. Applicant Signature ~(U~'~(N~ Signature of parent/guardian if Age 15 to 17: Address 836 West Side Drive Iowa City, IA 52246 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 3 of 7 19b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE One Vacancy -Unexpired Term Ending January 1, 2011 Duties of the Public Art Advisory Committee include developing by-laws and procedures for the Iowa City Public Art Program; administering the Public Art Program by determining the placement of public art, the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the Public Art Program budget. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m. Applications must be received by 5:00 p.m., Wednesday, March 26, 2008. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Public Art Advisory Committee should be directed to Marcia Klingaman, Neighborhood Services Planner at 356-5237. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 2 Council Announcement Date: February 19, 2008 Application Deadline: Wednesday, 5:00 p.m., March 26, 2008 Council Appointment Date: April 1, 2008 PUBLIC ART ADVISORY COMMITTEE One Vacancy -Unexpired Term Endning January 1, 2011 Barbara Nicknish resigned Annadora Khan ^D 923 Dearborn St Thomas Aprile O 50 Lakeview Place NE Alden Lowell Doud ~ 221 E College St #1001 Emily Carter-Walsh D (Previously served two three-yr terms) 1209 Seymour Ave ODenotes applicant completed the Confidential page of the application. Public Art Advisory Committee Attendance Record 2008 Name Term Ex ices 1 / 17 2/7 Barbara Nicknish O1/O1/11 X -- -- Data ne Williamson 01/01/09 X O/E Jan Finla son O1/O1/11 X X Mark Seabold O1/O1/10 X X Patrick Carne 01/01/09 X X Rick Fosse X X Ter Trueblood X O/E Key: X = Present O = Absent O/E = Absent/Excused Public Ar€ Advisory Committee Attendance Record 2007 Name Term Ex fires 2/1 4/5 5/3 6/28 8/2 9/6 I1/1 12/7 Emil Carter Walsh O1/O1/OS X O/E X X X O/E X X Data ne Williamson 01/01/09 X X OB X X X X X Emil Martin 01/01/08 O/E X X X X X O/E O/E Mark Seabold 01/O1/10 X O/E X X X X X X Patrick Carne 01/01/09 -- -- -- -- X X X X X X Rick Fosse O/E X O/E X O\E X X X Terr Trueblood X X X O/E* X X X X Key: X = Present O = Absent O/E = Absent/Excused City of Iowa City - r 1 ~.,:.®~ Advisory Board/Commission/Committee ~: ~"'~'~~ ,~®,~~ ..pplication Form -~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen),. typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Public Art Advi Youth Advisory Commission, Age on the date of filing: Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: \ME Annadora Khan HOME ADDRESS 923 Dearborn St Term;l- -Age 1~~-=to 21. - , c~ - ~~ _ ., , ~ ._. _ r•~~ ._ . .-, ~ r ~~ ZIP 52240 Is your home address (listed above) within the corporate limits of Iowa City? Q Yes ~ No How long have you been a resident of Iowa City? 33 years OCCUPATION Library Assistant 111 EMPLOYER University of Iowa Libraries PHONE NUMBER: HOME 319-354-8413 BUSINESS 310-335-5447 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I hold an MFA in Art from the University of Iowa. I'm involved with the Longfellow Association and have been treasury for the last 4 years. I'm interested in enlarging the scope of my involvment with Iowa City commissions I think that this particular opening is of interest to me because of my art background which continues in my job as supervisor of a Multimedia computer lab where people deal with images continually. I also have a gallery in NY and have another solo show planned for May 2009. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have no present knowlegdge of the advisory committee. I do recognise at least one name from the committee and am familiar with this persons personal art work. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As I stated previously I'm applying because I feel that my background and work experience make me qualified to sit on this committee. I think my knowlegde of art the committe may find helpful in their future projects. I also feel that where ever organization I am a part of I try to contribute as much as I can. _ k 1 j`~ r,~ . - _' ' ~..' PQTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Public Art Advisory Name Annadora Khan Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. acquired in an additional business. Applicant Signature Signature of parent/gu~rdian if Age 15 to 17: Address 923 Dearborn St Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. i r . r ' D~ ~~~.® ~III~~ ~ .~, w ~'~~ ~~ CITY OF IOWA CITY Date 11 /28/2007 General Application December 2006 Page 3 of 7 NOTE: A new form must be completed if the above information changes or an ownership interestis City of Iowa City _ ~ r 1 _~.~.®~ Advisory Board/Commission/Committee ~.,~"'~~ ,=~ppl ication Form ~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name . ~ /~ J 1Sa ('t~ Termer ~- ~ ( ~ Youth Advisory Commission, Age on the date of filing: Age 15 to 17 (or) Age 1Stp 21 Signature of parent/guardian if Age 15 to 17: , -~. 1 p inn- ~ p ~ ` . MME ~ A, ~ ~ ~~ -~v ~J A _---- - , i HOME ADDRESS ~ ~-~'~e.J I e ~ ~ ~ u.Ce ~ ~ 1~.-,o ~~~Pc' Z4P 5 `~ Is your home address (listed above) within the corporate limits of Iowa City? C~Yes ~ No How long have you been a resident of Iowa City? ` 2 ~f ~ 0. ~ S OCCUPATION S ~~ l ~ ~ti~ re Q ro ~~ S S 6 ~ EMPLOYER ~h t J ~ a ~ ~ ©~ ~-- PHONE NUMBER: HOME ~5~ ~ b L( BUSINESS 3 ~3 - 17 7 ~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY,oYOU FOR THIS POSITION:^ \ ~ ~ Uv2 ~ ~ S Q ~7 0 ~ S S f, p~i, r~ -- 'tom ~ r ~~~r ~ ~ a1 S ~ S q ~ r- ~e d c~Y ~~`L. ~ Cti.. 1 ~'~e ~ ~~e-_ S I t~-f~h1 Z- Y e cvc.S c~. s ~~ P Q ~ ~ S c~`"v!V ~~~ Ct.~-~~ d) ~-'L~ ~F (n ~ / c~ .~ow~ ~-~ vie S e s~'vt ~~ ~ ~d ~ y ~e t/ ~ o w s ~ ~~~ u ~ ~'~ ~ S~ G~ n C t.,lv Q~ ~ ~ ~ U ~n ti ~ 1.~ Oi P 9 ~ ~'~ GI dl U I ~.! V 1 (° J ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~~ G G7 ~~ (~ ~ f ~~ ~`Q I1 ~d.'~ ~ S ~ a L~"j' S ~t,J~--~ ~t~,~t1 `~- ! WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? '~ e c att,~-e ~~ rvv~~ ~~-a ~, y y ~cc,2s ~1~ ~e v~u-~-~ c i~ t ~-t^c.~lz-~i, 5 ~~~~~ •~ v~' N r°S ~i ~~i I Cis-e~~ ~ v~r ~ C a~ arc ate ~ ~ C¢-M-, ~ -~ ~-,,t- ~~ ~ r~U ~a Se r ~ ~, POTENTIAL CONFLICTS OF INTEREST _~= ' Please identify any potential conflicts between membership on the advisory board and ;your personal interests,including financial interests and your duties to an employer. „~ particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of 7 ~ r 1 :..®~r,~ ~ ..:u, A- BOARD, COMMISSION AND COMMITTEES •~~'~ QUSINESS LISTING ..,.~.,i._ CITY OF IOWA CITY Name of City Board/Commission/Committee ~ %~ ~ ~ vZ S~ cJ~~j ~~~ Date I Z -c7~~ -C3~ ~~ Name fz /~1 ~ r Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS ~. NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an adJt~~aH7a~ir~ess. ! ~ Applicant Signature Signature of parent/guardian if Age 15 to 17: Address ~ Lie ~ i C' Ke P L Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 3 of 7 City of Iowa City ~ r j Advisory Board/Commission/Committee ~;~ ~;~!'~~ .~ -.pplication Form -~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. r1 Advisory Board/Commission/Committee Name y 4 ~ ~ i c A r~ ~d y%S ury ~m~ ~{~Term~~ Youth Advisory Commission, Age on the date of filing:Q Age 15 to 17 (or) ~ Age 18 to-21 Signature of parent/guardian if Age 15 to 17: . ~''ME W ~dcr~ ~nw~ll ~u.c~ HOME ADDRESS e2 2 i 0 ZIP S~2~y~ o Is your home address (listed above) within the corporate limits of Iowa City? ~es ~ No How long have yoyyu~~been a resident of Iowa City? ~; n~~ ~w~ I ~~~ OCCUPATION Re~~ rG cI EMPLOYER - PHONE NUMBER: HOME ,33 t ~ ~s`47 BUSINESS --- EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: A # c -- •^~ : rs rri.e n ~ a, rL'~ lyts~ o r~ C W r-+-a G U.' u ttit J /~ ~ ~ /r~ ~ ~ ~ O M.d, i M. Q r~ -I 2Y 'f~e 1. oat~~aw ~~ ~ h.S~~~~.Y~. oJ' Qrr'I`~,~on.do»~ ~v tlow-ec~ n.~~~ a~/~ur'~"~.e.r3~fxrS~r a-~ 1"la.. ~I o,rs1 C-'~wa.dk.~c.7fe Ctnd-~r~o~ cl'~d.o r~~~ Y~ av~-s S~c~c~~^~~W cw lori'1~~t947c~- !q9'~) 1 ~ 4 VrB"~(6 e C h a C o l ~ e~'~-a ~ 0f T tri /- ~ ~ et i nr~ ; rL/ ~.S G7 n. C~ a 7'a ~, t'•S c w I O ~t w rG4+ ~3-o-rte./ Man t V / ear g ~ and 4 C e r~St a ~ -t r~ 4 d pv a t ac r'F l~- ~ s ~e r~ G r, c~ a r ~~f o ur H-k V3 ~0 1 hn. Pro be w~, Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ^tra.x. the ~~~e'r n~+~W~bs~~e an~ o~~~~-f-5 ~~aced tnr, 42c;Pa11~ o~ ~ (u. ~l~t$'I'r:an P~1:il WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~~ ~ ave a ~o -,,n Pre ~'-~wS ~ ~e ~ce y 1--~ ~~5/ k n ~w ~e~~c °~ n,o<sT °~ ~~-e. t-7rn~ar~s-,.~ C~t-'1' rn-a,-e rr. GwT s( "7' r b rn[~ ~ 1'~¢ `qqJ~~ ~ t~.S <~` t~,. L', e -,~ ~.,, r; m s k ry ~ : ~ n s w-. ~l' ~ ~, V' e/ .5 ®-rn- z k n su, J e tl ,~ c ^!~ G w ~ fi ° r ~ 4 ~~ r V''L u, 3~-w vw C o ~ (~ f.~ ~ rl.gF ~ rY ~ lt~ ~ G ~ ~ r° ~ ~ ~~ YCa~~n 4~'1 CS G.G6~d-e~vL ~t'~'Y r~p~.~ Qt-~' C'n L~U-ct. Y~ G~mn~rerre s-~S ~~hsvw ~ '1 ,~~ POTENTIAL CONFLICTS OF INTEREST ~_ Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6}. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. c~ n 1 A, opt ~ c ~ : eve ~'~: S Q!..,n. a 4, n.~ s ~ c ~+^ e /'L -~ ~ , c.~~ -~ w~' ~ a ~ a Y-t- e ~ ~ c L" a . . ~G,,,,~ ~,~ s' C6 w ti ~: l ~,~ U I Ni A ~ ~~! ~ Gov of - w.~----~ c~.~1 K-~,~ ~. ~~y) ~o-- v ~ mac. ~ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~'No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of 7 _~ BOARD, COMMISSION AND COMMITTEES ~,,~~~ ~~ '~ BUSINESS LISTING .~.t,,s,._ CITY OF IOWA CITY Name of City Board/Commission/Committee ~w ~ ~ ~ c ~ r~ ~ ~ y ~ e r, C o M M ~ ee Date ~ ~ ~- 0 7 Name /a jde n ~.®us~- t l ~ u,d Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature, Signature of parent/guardian if Age 15 to 17: Address 2~~ ~" ~o-l(c~rc ~~.-, #~ . ~ /d .h Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 3 of 7 City of Iowa City ~ r 1 ~..®dr Advisory Board/Commission/Committee ~' ~""+~~~~ ~~,~ .'' pplication Form -^~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 414 E. Washington St., Iowa Clty, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name~~~r~ic ~1~T r4~~isbiZ~-t~r~~~~~~ Term ~ a~ - i i Youth Advisory Commission, Age on the date of filing:Q Age 15 to 17 (or) ~_Age 1~=to 21 Signature of parent/guardian if Age 15 to 17: ~ _ - ,; NAME ~_v~ni L~ ~ fi-~-~'~-- ~~~4r ~F-4 __. .. ~f c~ HOME ADDRESS c~ ~I-P ~~ Is your home address (listed ab ve) within the corporate limits of Iowa City? ®Yes ~No How long have you been a resident of Iowa City? OCCUPATION ~F't~t~2 EMPLOYER ~cLi- PHONE NUMBER: HOME lei ~~ [o~SX~-~i ~~~ BUSINESS r'~i~r~ ~~1 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: 5 ft t_o~ c: T ~ ~~ Pis i r~~ ~ ---T- ~-{.~1 ;1~ ~1 a-r~ Nt s Std -7 t% ~ r.:~ ~.~: r x~ 6 C F(,~ rUC.~ JrJ ~~~ L ~5~.~~ C.dtn~~S~/~r~t_ 6F 2~c..)~ L.~~ ttFFvr ~C, --~~~1-t '~3.~+C~~r~c~c>+~(..~, ~' ~~V,n ~'Z ~s i'EC ~v t_ ~ f- ~~ ~~ d.~{ ~c L> v-~ bE: Tim ~--~ D ~ K S ti-f~~ v I~t V'~-Lc('srtt 1-I- (STo Q i C.h' l~ t (._ t~ r ~=:~.~ f}--tJtJ i~tj f_~i~:'. L c~ L~P.~S ~ rC ,~F2T, ~ 1%cl~ `7 H~ ~ t\ 5T `~ c )C. -~~ A ~5 , `3 i -I C-i v ~ v A f ~i is D ~~i<.u ~ i c, K-r~~c.~ tx~.. ~ ~ ~~ ~.: -7 -tom S~ t..;~c 1-r r~ ~J P ~~l st i` }_-~ ~U'~3Li L ~}r?7~ ~t~~~~, ~~-- ~ffi/ ta's~-( ?~t{f~c~v6!-f `~ ~'7-tf-~„ ~~'ct5.7fi-~.~f~7~~a~a Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. ~~ General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~-- l ~~ C `~ ~ V C ~ I V~~ ~~~LIS ~` ~ (~ ~ ~V ~ ~`~ r*~CK- ~ ~~~ l 7~~ ~~ . WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? .= Ceti C:.~ rv t ~l g ~%7~ "~® Ttf~ i.~c"~t S ~ r~.:a Y~ic-i a~~e~ `~~ ~ ~ SS ~~ 71a ~~~ -K.~Jc:x.~i.~.~C~: p~ ~~1~i~~tf~~.~ ~U «Si~R'vCTZ~sJ, f~~.5-~~ritT~C. ~~ 1~1~U U 1~~ ® ~~Z? ~~ ~ ~t`~ ~{,C'r--C~ fj-i~~ ~~~ "S~Li~'-`I C C~~~,'~.~y~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. ~ .articular, if you are applying to be a member of a board or commission which makes recommendations tothe l,~cy Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about S;~~tion 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. ~ ' - _ __ ; ~, IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~' No ` DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of 7 ~;~:~®i~ BOARD, COMMISSION AND COMMITTEES ~,,~`~~ ~~~'~ BUSINESS LISTING ..,~.,.~ CITY OF IOWA CITY Name of City Board/Commission/Committee ~,=~-~ ~ Date +2 3 0 ~1 Name ~ vyt + ~-.f ~ t~i,T l ~:~ ~5 H Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS rJT l ~ in~c>. ~ ~ ~Q ~. ~ ~ Z i NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature Signature of parent/guardian if Age 15 to 17: Address Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 3 of 7