HomeMy WebLinkAboutAgenda Bill 5A-AnimalServices 08/03/2009 AI'U _ w
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Instructions:, Use this form to apply to serve on any of the City of Petaluma, California~s~~ ~xrds,
Commissions, or Committees. Please. fill out the form completely: !f a question does not apply, type or
write NJA in the space provided. When completed, please forward to the City Clerk's Office City of
Petaluma, 1 1 English Street, Petaluma, CA 94952. All applications are reviewed by the City Council.
'Name:
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Home Address, City, State and Zip Code:
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E-Mail: (11_uppointed, do you want this address to
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Are;.you a registered voter in.Petaluma? If so, for how long?
YES ^ NO
Board(s), Commission(s), or`Committee(s) of Interest*:
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*Note: To serve..on;the,Senior Advisory Committee, you must:°be age 55 or above.
Havre you attended a meeting.of this Have you served on, interviewed, or applied for
body? this body previously?
.YES. L~4, NO ^ YES NO
Colglazier, Margaret
Animal Services Advisory Committee
i Present Employer:
Job`Title:
i Previous Governmental Bodies/Elective Offices you have served, Position/Office Held and
Dates:
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Civic or Charitable Organization to,which you have belonged, Position/Office'Held, and
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What Special.Interests/Skills/Talents would you bring to this Board, Commission, or Committee?
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Special Awards or Recognition Received:
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Please state 'reasons why you wanf to become a member of this Board, :Commission or
Committee, including what specific objectives you would be working toward`as a member of.
this advisory body: ,
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Is there any other information that you feel would'be useful to the City Council in reviewing
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Areyouu associated with any Organization/Employment that might be deemed a conflict of -
interest in performing your duties if appointed to this position?
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If yes, please state name of Organization/Employment:
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City policy directs all :appointed,, advisory botly members `not to vote on matters where there
exists a potential conflict of interest. Would you be willing to abstain from voting if such a
conflict arises?
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YES ^ NO
How did you hear about this opening? "-
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.Applicant's Signature , -.
Date ` `
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Revised August 12, 2008
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City `Board, Commission and Cort~mittee Applii;
Instructions: Use this form to apply to serve on any of the City of Petaluma, Califc~rnru s~cuc~-
Commissions, or Committees. Please fill out fhe form completely. If a question does not apply, type or
write N/A in the space provided. When completed, please forward to the City Clerk's Office City of
Petaluma, 11 English Street, Petaluma, CA 94952. All applications are reviewed by the City Council.
Name:
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Home Address, City, State and Zip Code:-
Home Phone: (If~appointed, do you want this
number to be available'fo fhe public?J I~IorkPhone:
YES ' ~ NO
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E-1Vlail: (If appointed, do you want thisaddress to
FAX:
be avarlable to the_public?) ~ YES ^ Id0
Are.you a'registered vo#er in Petaluma? If so, for hover lang.?
YES ^ NO /~7S
Board(s), Commission(s), or Committee(s) of Interest*:
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*idote: To serve on the Senior Advisory Committee, you must be age 55 or above.
Have you attended a meeting of this Have you served on, interviewed; or applied for
body? this body previously?
,~ YES ^ NO ^ YES ~NO
Dyer, Rober "Bob"
Animal Services Advisory Committee
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Present Employer:
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Job Title: `
Previous Governmental Bodies/Elective Offices you have served, Position/Office Held and'
:Dates:
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Vllhat Special Interests/Skills/Talents would you bring to this Board, Commission,'or Committee?
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Special /4wards`'or Recognition Received:
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Please state reasons why you want o become a member of this Board; Commission or
Committee, including whatspecific objectives you would be working towardas a member of
..this advisory body:
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Is there any other information that you feel would be useful to the City Council in reviewing
your application?
Are you associated with any OrganizationJEmployment that might be deemed a conflict of
interest inperforming'your duties if!appointed to this'positian?
^ YES C~ NO
If-yes, please state name of:Organization/Employment:
City-:policy directs all appointed, advisory body members not to vote on matters where-there
exists a potential conflict of interest. Would yoU be willing to abstain from voting if such a
conflict arises?
YES ^ NO
How did you hear about this opening?
Applicant`s Signature Date
Revised August 12, 2008
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