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HomeMy WebLinkAbout1999-11-23 AppointmentNOTICE THE CITY COUNCIL OF IOWA CONSIDERING APPOINTMENT FOLLOWING BOARD: CITY IS TO THE BOARD OF ADJUSTMENT One vacancy - Five-Year Term January 1, 2000 - January 1, 2005 Duties: In appropriate cases and subject to appropriate conditions and safeguards, the Board may make special exceptions to the terms of the Zoning Chapter in harmony with the general purpose and intent of the ordinance and in accordance with general or specific rules contained therein. The Board may grant variances to the Zoning Chapter only in the case of "unnecessary hardship." The hardship must be substantial, serious, real, and of compelling force, as distinguished from reasons of convenience, maximization of profit or caprice. The Board may also hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by a City official in the enforcement of the Zoning Chapter. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the second Wednesday of each month at 5:00 p.m. This appointment will be made at the November 23, 1999, meeting of the City Council at 7:00 p.m. in the Council Chambers. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's Office upon request. 9/28/99 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: 3 Females: 1 November 23, 1999 BOARD OF ADJUSTMENT One vacancy - Five Year Term January 1, 2000 January 1, 2005 NO APPLICATIONS AS OF NOON 11/10/99 Dennis J. Keitel [] 1696 Ridge Road (has also applied for Parks & Recreation Commission) [] Denotes applicant completed the Confidential page of the application. NOU-11-1999 15:11 HALL & HALL ENG. CITY 'OF IOWA CITY ADVISORY BOARD/COMMISSION [ ?PLICATION FORM 5193629548 P. 05/0? ----- ~ O~-, co Individuals serving on Boards,/Commissions play an important role in advising the Counc~n ma~'ers 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. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBUC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL' THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME, ADVISORY BOARD/COMMISSION NAME Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes How long have you been a resident of Iowa City? PHONE NUMBER: No EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: T, or WHAT I~ YOUr PRE~ENT KNOWLeDgE OF THIG ADVISORY BOARD? ~CC~ o~ WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON NOU-11-1999 15:11 HALL & HALL ENG. 3193629548 P.06/07 SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 rime.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all questions on the application you may not be considered for appointment. i;," "k%iiOCm~rn3D~,dOC r]J. anuary 3998 ,r---'--' NOTICE THE CITY COUNCIL OF IOWA CONSIDERING APPOINTMENT FOLLOWING BOARD: CITY IS TO THE BOARD OF APPEALS One Vacancy - Five-Year Term [Building Design Professional] January 1,2000 - December 31,2004 It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. This appointment will be made at the November 23, 1999, meeting of the City Council at 7:00 p.m. in the Council Chambers. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered for this position should contact the City Clerk at the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's Office upon request. 9/28/99 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: 5 Females: 1 November 23, 1999 BOARD OF APPEALS One vacancy Five Year Term (Building Design Professional) January 1, 2000 - December 31, 2004 NO APPICATIONS AS OF NOON 11/10/99 NO APPLICATIONS AS OF NOON 11/18/99 [] Denotes applicant completed the Confidential page of the application. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies - Three-Year Terms January 1,2000 - January 1, 2003 The duties of the members of the Human Rights Commission are to receive and to determine the merits of human rights complaints alleging unfair or discriminatory practices in the area of employment, credit, public accommodation, education, and housing. The Commission shall provide conciliation and the enforcement necessary to further the anti-discriminatory goals of the Human Rights Ordinance and to protect citizens from unfounded charges of discriminatory practices. The Iowa City Human Rights Commission has an obligation to investigate and study the existence, character, cause, and extent of discrimination in Iowa City in order to eliminate discrimination by education, conciliation, and/or enforcement. It is also the duty of the Human Rights Commission to draft revisions to the Human Rights Ordinance if necessary to eliminate prejudice, intolerance, bigotry, and discrimination. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Human Rights Commission meets once a month at 7:00 p.m. Appointment will be made at the November 23, 1999, meeting of the City Council at 7:00 p.m. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's office upon request. September 28, 1999 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: 5 November 23, 1999 HUMAN RIGHTS COMMISSION Three Vacancies - Three-Year Terms January 1, 2000 - January 1, 2003 Colette Brodersen [] 904 #rd Avenue Jan Warren [] (has served one full term) 815 N. Johnson Street AS OF NOON 11/10/99 Charles A. Major [] 7 Blue Stem Court Mettie Th0m0pul0s [] 75 Shagbark Court Tammy Spies [] 1121 Ash Street (has served an unexpired term) (has served an unexpired term) Maureen Howe [] 411 Reno Street [] Denotes applicant completed the Confidential page of the application. 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, stepmother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 5 November 23, 1999.,~ HUMAN RIGHTS COMMISSION Three Vacancies - Three-Year Terms January 1, 2000 January 1, 2003 ,.,. Colette Brodersen [] 904 #rd Avenue Jan Warren [] (has served one f~{Lterm) 815 N. Johnson Street AS OF NOON 11/10/99 \~. Charles A. Major [] 7 Blue Stem Court Mettie Thomopulos [] 75 Shagbark Court (has served an unexpired~"~erm) (has served an unexpired term) []/D no applicant completed the Confidential page of the application. , e tes / / CITY OF IOWA CITY ADVISORY BOARD/OOMMISSiON ' PPLICATION FORM "'~ .... c~ E" Individuals serving on Boards/Commissions play an important role in advising the Co¢c~n ~atteE~f 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~.'e wo~ session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Is your home address (listed ab e) within the corporate limits of Iowa City? V'~es ~ No How long have you been a resident of Iowa City? EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ .c. (.~.~ ~.,~,~J~-lL jr's- SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? YES _~_NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? .~(ES "'~' 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 questions on the application you may not be considered for appointment. cclerk%bdcomapp.doc January 1998 ATTACHMENT TO APPLICATION FOR HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect citizens of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure the Human Rights Commission is representative of the community and the groups which it serves. Therefore, "[a]ppointments shall take into consideration men and women of various racial, religious, cultural, social, and economic groups in the city. (Ord. 94-3647, 11-8-94) ~. Please indicate if you are a member of any of the following categories es~on_s voluntary): 62 years or older ~ Handicapped or Disabled ~/~acial or Ethnic Minority Male L/-'/~emale Lower Income CITY OF IOWA CITY ADVISORY BOARD/COMMISSION [ PLICATION FORM .-~c.:; ,'> [" Individuals serving on. Boards/Comm[.ssions play an !mp.ortant role. in advising the Coun~;?~)~'~ ma~rs ~nterest to our community and ~ts future. Apphcants must remde ~n Iowa C~ty. ._~ _~- After a vacancy has been announced, the Council reviews all applications during t~ worl~ession. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers.co PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME Human Rights Commissioner TERM 2000-200B NAME Charles A. Major HOME ADDRESS 7 Blue Stem Ct. ,Iowa Citv,IA 52240 Is your home address (listed above) within the corporate limits of Iowa City? x~x~ Yes No How long have you been a resident of Iowa City? 76-86,90-94,97-present Or'CUPATION Respiratory Therapist,Pulm. Funct Lab EMPLOYERVeterans Affairs Medical Center PHONE NUMBER: HOME 319 337-3563 BUSINESS 319 338-0581 ext 6328 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:Previous Human Rights Commissioner 98-99,Served on County Mental Health Board 96-97,Resp Therapist VAMC 28 yrs Army Reserve 13yrs,Raised 2 sons n~ 18,22. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am aware of Human Rights ordinance because of my serving on human rights commission 98-present. I have read findings & case material in my commissioner position. Participated in all city and national traininR on human rights over 2 yrs. W R HAT CONT IBUTION$ DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? With my prv~o-q knnwlpdgp fi nWOrpnpq~ nF hnmnn rlgh~ ~n~v~ip~ T hope Co be an advocate for human rights & fight along with others discriminaSion per city ordinance & state ~ws.I hope to better educate the Iowa City area about human rights & the Iowa City Hunam Rights Commission. I hope to participate in future state human rights & civil rights training- to m~kP myself a better commissioner. SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. No conflicts nf inrerP~r T knn~ nf. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? xxxxYES __NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? )YES xxx 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 questions on the application you may not be considered for appointment. cclerk~bdcornapp,doc January 1998 ATTACHMENT TO APPLICATION FOR HUMAN RIGHTS COMMISSION It is the mission of the Iowa C. ity Human Rights Commission to protect citizens of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure the Human Rights Commission is representative of the community and the groups which it serves. Therefore, "[a]ppointments shall take into consideration men and women of various racial, religious, cultural, social, and economic groups in the city. (Ord. 94-3647, 11-8-94) Please indicate if you are a member of any of the following categories (your response is voluntary): __ 62 years or older xxx Handicapped or Disabled Racial or Ethnic Minority ~ Male Female Lower Income Service Connected Disabilty,Receive Compensation from Veterans Affairs ClT~ 0F'IOWA CITY ~o ~ z~ ~. ADVISORY BOARD/COMMISSION m APPLICATION FORM Individuals se~ing on Boards/Commissions play an impo~ant role in advising the Coun~ on ~ m~ers of intere~ 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. Th appointment is made at the next formal Council meeting. Appointees sere as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 43 0 E. Washington St., Iowa Cit% Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FO THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED 'CONFIDENTIAL' THIS APPLICATION WIL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANC DURING THAT TIME. NAME (~&&UV~--Cn/-~,v~f._ HOME ADDRESS qll 7~eno ~ee-I', Io~ Is your home address (listed above) within the corporate limits of Iowa City? ~Yes No How long have you been a resident of Iowa City? I ~ PHONE NUMBER: HOME ~l~, ~58' fibril BUSINESS ~l~' ~?' EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~ FOR APPLYING)? A~ ~o~ ~no~, ~,l,~'e~ ~ no, &~Q,~i~ ~o.~ Fo~ec~ c~{c~,~, SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 questions on the application you may not be considered for appointment. ccterk\bdcornapp.doc ATTACHMENT TO APPLICATION FOR HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect citizens of the city from discrimination as defined'in the Human Rights Ordinance. In order to further this goal, the city strives to ensure the Human Rights Commission is representative of the community and the groups which it serves. Therefore, "[a]ppointments shall take into consideration men and women of various racial, religious, cultural, social, and economic groups in the city. (Ord. 94-3647, 11-8-94) Please indicate if you are a member of any of the following categories (your response is voluntary): __ 62 years or older __ Handicapped or Disabled __ Racial or Ethnic Minority Male ~'/Female ~/' Lower Income N0v-t-8-99 02:21pm From-CITY OF IOWA CITY +3193565009 T-180 P.03 F-269 2_~ c CiTY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commlsslons play an important role in advising the Coun~m~rs o~nterest to our community and its future. Applicants must reside in Iowa City. ;;--: " After a vacancy has been announced, the Council reviews all applications during t~e world:rSession. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~tt~,rfi~r~k"'R,~,.5. h~5 .......... TER&Z-~r~o- ~n,~ Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes __ No How long have you been a resident of Iowa City? }'~ ~/CS. OCCUPATIOi~.C~-'i~L S-i- PHONE NUMBER: HOME~,~q :~ [~SLI ... EMPLOYEFeff.,~I. BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~2: WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON N0v-iB-gg 0Z:2Tpm Fr0m-CITY OF 10WA CITY +3193585009 T-iS0 P.04 F-ZEtl SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY, OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARb OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 al3plication will constitute just cause for removal of an appointee. !f you fail to answer all questions on the application you may not be considered for appointment. ; cletld, D(3comlpO.doc January 1998 .Nov-iS-g9 02:22pm Fr0m-CITY OF 10WA CITY +3193565009 T-180 P.06 F-Zag ATTACHMENT TO APPLICATION FOR HUMAN RIGHTS COMMISSION !t is the mission of the Iowa C. ity Human Rights Commission to protect citizens of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure the Human Rights Commission is representative of the community and the groups which it serves. Therefore, "[a]ppointments shall take into consideration men and women of various racial, religious, cultural, social, and economiC' groups in the city. (Ord. 94-3647, 11-8-94) Please indicate if you are a member of any of the fo]!owing categories (your response is voluntary}: years or older Handicapped or Disabled Racial or Ethnic Minority _Z~Lower Income NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PARKS AND RECREATION COMMISSION Two Vacancies - Four-Year Terms January 1, 2000 - January 1, 2004 The duties of the members of the Parks and Recreation Commission are to recommend and review policies, rules, regulations, ordinances, and budgets relating to parks, playgrounds, recreation centers, and cultural functions of the City and make such reports to the City Council as the Commission deems in the public interest; to exercise broad responsibility for the development of parks, recreation centers, playgrounds, and cultural facilities to serve the City--including the creation and appointment of advisory groups to make studies. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Parks and Recreation Commission meets the second Wednesday of each month at 5:00 p.m, Appointment will be made at the November 23, 1999, meeting of the City Council at 7:00 p.m. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's office upon request. September 28, 1999 -23-99 23d 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: 4 Females: 3 November 23, 1999 PARKS AND RECREATION COMMISSION Two Vacancies Four-Year Terms January 1, 2000 - January 1, 2004 Allen Stroh [] 3023 Cornell (has served one full term) AS OF NOON 11/10/99 Dennis J. Keitel [] 1696 Ridge Road James W. Moxley [] 2040 Waterfront Drive (has also applied for Board of Adjustment) [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION /' ' PLICATION FORM o m.... Individuals serving on Boards/Commissions play an important role in advising the Coun_~'~ m~<~ers 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 sere as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 4.10 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. NAME'~/I,q~"',,.,C [~2/4q~)XLE~2' HOMEADDRESS~-0'~'(~TM M/'~--~F~/~/Y~' Is your home address (listed above) within the corporate limits of Iowa City? K Yes __ No How long have you been a resident of Iowa City? EL~"'//~"/J ~'~ Or'r:.UPATION G~D~~ ~ T~0~) T~m'To~ EMPLOYER ~ Q Fy ~b'c U~ VHON~ NUMBER: HOME 33/-22 ~o BUS~NESS 3~ -- ?~O~ ~./~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~ ? ,~ WHAT CONTRIBUTES DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE ASON FOR APPLYING)? SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST, PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? .. YES .,X 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 questions on the application you may not be considered for appointment. cclerk\bdcomapp .doc January 1998 (2) NOV-11-1999 15:10 HALL & HALL ENG. 3193629548 P.02/07 CITY 'OF IOWA CITY ADVISORY BOARD/COMMISSION : ?PLICATION FORM _ Individuals serving on Boards,/Commissions play an important role in advising the CoLOn ~at~e~of interest to our community and its future. Applicants must reside in Iowa City. 3> ~ After a vacancy has been announced, the Council reviews all applications during the w~ session. The appointment is made at the ne~ forma( Council me~ing. Appointees sere as unpaid volunteem. PL~SE USE A B~CK INK PEN. R~urn the application to Ci~ Clerk, 410 E. Washington St., Iowa City, Iowa. ADVISORY BOARD/COMMISSION NAME 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 'CONRDENTIAL' THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. !s your home address (listed above) within the corporate limits of Iowa City? :~. Yes No How long have you been a resident of Iowa City? PHONE NUMBER: HOME ~> ,~' '/F' ' I cf ~ c~ SUreNESS 2~ 6 '~ - '=/ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD {OR STATE REASON. NOU-11-1999 15:10 HALL & HALL ENG. 3193629548 P.03/07 Src~CIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Y',,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 fa~ to answer all questions on the application you may not be considered for appointment. cclefk~,dcomapg,doc NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION Two vacancies - Three-Year Terms January 1, 2000 - December 31, 2002 The duties of members of the Senior Center Commission are to: 1. Serve in an advisory role to the City Council with regard to needs of the Senior Center. 2. Make recommendations with regard to policies and programs at the Senior Center. 3. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. 4. Encourage full participation by senior citizens in the programs of the Senior Center. 5. Ensure that the Senior Center is effectively integrated into the community and cooperates with organizations with common goals in meeting the needs of senior citizens. 6. Serves in an advocacy role with regard to the needs of senior citizens in Iowa City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Senior Center Commission meets the third Tuesday of each month at 3:00 p.m. Appointments will be made at the November 23, 1999, meeting of the City Council at 7:00 p.m. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's office upon request. 9/28/99 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: 3 Females: 2 November 23, 1999 SENIOR CENTER COMMISSION Two vacancies - three Year Terms January 1, 2000- December 31, 2002 NO APPLICATIONS AS OF NOON 11/10/99 Ken Fearing [] 605 Manor Drive Harold Stager [] 201 N. First Avenue #302 Robert L. Welsh [] 84 Penfro Drive Lori Benz [] 201 2 Dunlap Court Charity Rowley [] 519 Park Road [] Denotes applicant completed the Confidential page of the application. 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, >-child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 2 1999 SENIOR COMMISSION Two vacancies 'ee Year January 1, 2000- 31 NO APPLICATIONS AS O! 11/10/99 Ken Fearing [] 605 Manor Drive Harold Stager [] 201 N. First Aven Robert L. 84 Penfro Driv Lori Benz 201 2 Dunl~ Court #302 [] Denotes applicant completed the Confidential page of the application. CITY OF .IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME/~24'/Z.,d:~ ~ TERM HOME ADDRESS ~/~,~ ~~ ~ Is your home addres e) within the corporate limits of Iowa City? ~ Yes No PHONE NUMBER: HOME ~~;~3~~ ~ BUSINESS WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE, 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 ,%d 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 questions on the application you may not be considered for appointmex>,t. cclerk\bdcomapp .doc (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council onematterS'of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been annouhced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Is your home address ( above) within the corporate limits of Iowa City? ~es ~ No How long have you been a resident of Iowa City? OCCUPATION PHONE NUMBER: HOME vZ'~7 EMPLOYER BUSINESS WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON . --- ,, SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY, AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 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 questions on the application you may not be considered for appointment. cclerk%bdcomapp .doc January 1998 (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME NAME a b ff/,, HOME ADDRESS Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? OCCUPATION ~l~ir~t~/~t PHONE NUMBER: HOME EMPLOYER BUSINESS Yes No EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ATTACHMENT TO APPLICATION Robert L. Welsh Senior Center Commission EXPERIENCE AND/OR ACTIVITIES V~{ICH YOU FEEL QUALIFY YOU FOR THIS POSITION. I have a history of services to Seniors. I was a major force in urging the City to purchase the Old Post Office for use as a Senior Center. I served as one of six members of the committee to plan the Senior Center jointly with Ecumenical Towers. I was founder and organizer of the Ecumenical Housing Corporation. I am currently Chair of the Johnson County Nutrition Board. I have served as Chair of the Budget, Program and Planning Committee of the Heritage Area Agency on Aging and I am thus familiar with the program and services of many of the agencies that serve Seniors, not only in Johnson County, but in the seven-county area. I served the City as the first chair of the Housing Commission and the first chair of the Cable TV Commission. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have attended meetings of the Senior Center Commission and have read many of their reports. WHAT CONTRIBUTION DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING) I have a strong belief in the value of co-location of services for Seniors I would be particularly strong in assisting with "Duties and Powers" #4, #5 and #6. I am a strong advocate for senior citizens, I would seek to help empower seniors and work build collaborative relationships. I am applying because I feel I can help. November 18, 1999 SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 L'INO (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 questions on the application you may not be considered for appointme__nt. cclerk\bdcomapp .doc (2) CITY'OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Councllrj~ _rf~_ter,~ 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 woL. E; session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers.> PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 4i 0 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME Senlet O~¢~r Co~mZ ~s,'~ TERM ~ Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes No How long have you been a resident of Iowa City? ~ PHO~U~s~a: HO~S 5~q~!~S SUS~SS 555--~5~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:?~$~~ ' - '. . . WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ ~ ~ ~ ~ ~*~ q~,~~ SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY, OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 questions on the application you may not be considered for appoi~:ment. cclerk\bdcomapp.doc ~J~uary ~__ 1998 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM ~ CS> ~a 1 :< F' .r'r'i .~. "" Individuals serving on Boards/Commissions 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COM~JSSION NAME · A HOME ADDRESS '5",,/z9) '~/t"'~' ?~. j T~ O'cr%:~ ,9",~ Is your home address (listed above) within the corporate limits of Iowa City? ~....... Yes ~ No How long have you been a resident of Iowa City? PHONE NUMBER: HOME BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: , WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 questions on the application you may not be considered for appointment. cclerk\bdcomapp.doc Jan~ 1998 (2)