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HomeMy WebLinkAboutStaff Report 4.B Appointments Part 11 Tree 06/20/2011iw r f I i i TREE ADVISORY COMMITTEE ONE VACANCY TO COMPLETE A TWO-YEAR TERM EXPIRING .JUNE 30 2012 AND THREE VACANCIES FOR TWO -YEAR TERMS EXPIRING .JUNE 30 2013 0 IivaS�r + �wL S +r s 1 b k Mission , an, C 0 61 rnitFee Instruct se t form to apply to serve on any of the City of Petaluma, Ii Commissio C ommittees. Please fill out the form completely. If a question doe t app or write N/A in the space provided. When completed, please forward to the City Cl Office Cr Petaluma, 1 l English Street, Petaluma, CA 94952. All applications are reviewed by the c> 202 °Name �R �;. �. �x � ' � �� � x k tlr,�•r �� � �� � � , - I �� >' I . j `Ho'me Address, City, State and Zip Code +. Home Phone (If,appainted do this ��n�umber t pubUc �� `, ' ��'�� Ph�onehc C ;F - w:. - uy a uy, ;, M °A .,A �s -4 - " ', E�Ma�I' F(Ifappornted do you wan�th to n y k. l �FAI a i- r €saddr � - Are ou istered voter m Petaluma If 2; _ � ❑✓ YES ® l -PAS g. y I "� .W'. r� a ,.tl:'Jk �' „. v - ' t6. II rBoard(s); Co,mmission(s)or�C.ommit#ee(s) of Interest* *Note: To serve on the Senior,Advisory Committee, you must be age 55 or above. 4� Have�you attended a meeting of thisp ;'Have you is ap`plied for���� y R tl bod�� ?�� iy a� h rr �on,interviewed this bodypreviousl y 7 };..r ,. YES ❑ NO YES ❑ NO �a r cst V r Scaccalosi, Rod Tree Advisory Committee 0 Page 2 of 4 % I g'p e' in"'t"Em I 0 t - a q h a , Previous - Olt "T - `h' �iAt'-'tidritd bl' ��Ofgdhiibtidhl hh W J� t VOffid' lYqlt! eonge, I, 'y 461 hii"866 f iftee� d! hM �ypv, ring,, -7 " AL C l 2 Hoc e Page 2 of 4 a. rF y 5 9 < ' , a,ll 144,- . r h¢ 1 3 J' �^ „R 4� f �Coiie_ge; Professional, uocational,Sc.hools Attended{ ;MatorSubtect; Dates ,Degree %Date) .+. �. a i,..��1:'V' s «Asa, "� a o-. �;.� 1qF. �� nFy a m 7, b„ ➢ - �"4 Sf ! ro� �1 Speciai�`Awards .. R'ecogmtiona � � a � t Received u 4 - a r4o #„ R" 3. '' �+ � ... >• .. Pleceses tate,reasons why }you 0 ' becorne rnem befythis Board, Commissi < on or ale �' � �” � r �, u..• � . Committee, including whatyspecific ob_ j ec #ives you ,w,ould be- w�orkinq oward; 1.d member of�s r his a s d, VIsoftybody '4 .im„ V � i , - °'�N�: ��'�Ir',�h " N��'! «In4w ,i *���� "`,., k ✓r ?„ A.w3. w"i�±.�� a'I'Fr?�fi� rHl '� '."��r,kd .x� �±T X91 � �. F n J t p I p ��, uld ,.Js�thereany, other ' :inform'ation that,you feeh wo1be � usefulto the 6City�Councilrin; k �, ur yOUrappilcation� �w��r'�� 6� u U m��eu� �iirwd� it ` .. �, ^*✓, q.,, n trW M •-2.- " VIP/VIE.e fm � �YVIYV�I ��� y • Page 3 of 4 2 Revised August 12, 2008 Page 4of4 Are you assgcrated z wrth3lany Organization /Employment�that might�b a conflict Oz + mmg yourlduties if appointed to, ,', positrons nterestAn�perfor T - .�� YES O'NO I.fiF h W - ` n�iF } 11 I R ' J fin: d 1 . � 'h 9 yjl w T { { ! fSY P� N t If yes;piease state name of Orgamaation / e � g u� �.� Js v .. �r� ,, .da. fit �k w � �C�rty,polieydirectssall appointed, ad vrsory�bodymembers no�t�tovotet�onmatterswhere�therei, exists a� otentral conflict of rnterest beawrllingi'46,dbstain,,,, from' "voting if�suchga P, `y N s wq r �, conflr,ct arises A li .nF t _ YES NO - J N4' 4'°, ak d, r 1 I I�tf How didjyou hearabout�'thrs�ope "ning� ", �, �� '� �x' " 1. m k w l �Yv" �rj0Vw4l � kc�CNIIA/I, E Applrcant Signature° Date r � 'F` 15 i Revised August 12, 2008 Page 4of4 , a I , ' I °7 A 0 TiZ L C 0 AA AA � 1 'U "�,�'3 � Gr� �: �iT1,1``4p� L' I 11. ie._ • n a w ;ICa ,Yo' C- CkAk ity�,Boiird,'Co ft"It on�cshr ;Comrriiitee Application ° . 85 ML o Instructions:_ is formY ply to serve on any of the City. of Petaluma, California's Boards,, Commissions, o eas e fill o.ut "the form comple #ely. If; a question' does'not apply, type or write N/A in :the space rovided. When 'co rnpleted, ,please forword to the City Clerk's Office City of Petaluma, 1 Eng Stre II et, Petolumd, CA 9 4952. All applications are,re,viewed by the City Council. I Name: L L ,. S61- 0 M , n�j HomeAddress, G City, r 1 M pr e 4'A 5 Z- o Home';Phbhe r(lf appointed} do you want this, Ile ` r number to be available to the p , u b6c? JUVorkPtione E ,I, i ®YES�R�iVO �4 r A �Ir� FE s , ,h dd d f appom�t do you want t is Tess to FAX: 1 ' y `the`'pu be' available to - ic NO - 3 , red Jam'' ��r Are ?x i - t - C t l h M 4� , I - *✓ � e how you a registe uoterJfiTdtaiuma �� If so,af or =long z .. �A; ❑ tkLj YES NO k .; Ir.X, *�'' i �, ... "' "'�. ° '4 ! i � I ' Board(s) Commiss!on(s) orpi of , interest* ♦ y ' r N III t n x _ _ •ww.'...ft- �{.a.,L' 15,.E ... .� ! 'ai`... A T R CIE C`' ©.Ivy ) A 1 TT yo _Note: To serve on the Senior Advisory Committee u •._ mu st b e; nge 55 or above. I I 4 Have youjdttended a meetin of this .- 9u 4 y i - � have ou served on ;interviewed, or a he for Y PP w l f r� { 7' v �' AI v -' h F "3 t 1�- body• /� III �Y 1 '� this body�previously f r YES ❑ NO ❑ Y.ES' NO IL Present Employer i--T flp-C- �� h, >., I ' R- 1 Cl) Li j K I S -c- Vi ' 'r,' ` s -. w - Previous GoYernmentalBodies /Elec_ti�e Offices'you,have° served, Position /Office'Held and: • ,t �� Civic or Chatitable Organization to whichyouhaue belonged, Position /Office Held, and f 1 yow Jrt . 'IJftdt Speciolalnterests /Skills/Talents;wouldt ring to this iBoa�d; Commission or Committee: ?; jA C1tA -(x S C- ko�� Qv kv I-" u k c - ec v1 C rr {! &h 04 ; llv`r Page 2 of 4 , 'College, 'Professional,. Vocational ESchools At#ended ;;(AllatorSubject; Dates> °'Degree /Date): r Special Awards or Recogni #ion,Received: ti h ., Y M1 $ -y _ f } _: �JibG n J. y r i gv�r� } ar s jr � k � hF u t 4 +�' s� ' a i' .• ;: ,. P�leose state reasons why you ';want;M1to this Board, Commission or ,r�4 Iw ,S ,nGi,G� 1 6r u {hP ° I a � I -d' Comri ittee,'iricluding what specific ob�e,ctives »you would beWworking to' as:ci member of F this advisory body: - . I I^ iJG, ^'r. Is there any:atherinforrriation you feel,would beusefulto�the CityCoun "cilin r�evie�nring ur'application�' I , I 1 Page 3 of 4 V ' dal iF� ^a� r'_.i Its_ i� dr ti i,y �e►re you associated;,!with :any�Organiation /Employment thatnmight =be�.deemed a conflict,of 11 l interest ingperforming your'duties if appointed to. this position, r YES El NO If yes please statesname of�Organii'ation /Employment City policy`directs;ctl appointed, advisory b6dy n'6tYto vote on °'matters wherexthere �e dsts,a potential conflict of'iriferest Would yoo be wtlling�to abstain�fro,m,doting if'such conflict arises? t YES ❑•• NO ,' ��'How'did you" �hearaboutahisppening 1�'i�� i �rh m. �V�SS i ry hi, •, 1;� nr...F7' eAc R �t/�e w� �-v1 c '� 1 C i Applicant's Signature Dcit a`3 f ci, Revised August 1.2, 2008 Page 4 of 4 � '