HomeMy WebLinkAboutVan Cott Application 1989CITY OF CAPE CANAVERAL.
QUALIFICATIONS FOR SERVING ON CITY BOARDS.
1. Name ALS'A- /6- /1_, Z/4/1-) Cr. 0- _Home
2. Home Address:,..-La7 /-
3. Business:
4. Office Address:
5. Brief Resume of Education and Experience:
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Telephone: Y4)-/-7'7?-2,z77
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Business Telephone:
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47, 1.44,) / / " •
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6 A 17C you a registered Voter? Yes No 4
7. Resident of City for 12 months or longer? Yes Al No
No
s X
8. Do you hold a public office? Ye
9. Are you employed by the City? Yes No K
10. At the present time, do you serve on a City Board? Yes
No 2(
11. Name of City Board You Are Interested In Serving On: (Specify Preference)
(1st, 2nd, 3rd, etc.)
Beautification Board
Board of Adjustment*
Code Enforcement Board*
Library Board
Planning and Zoning Boar(J*
Recreation Board
12. Qualifications to serve on this 1iord a .
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13. Would you consider serving on another Board Other than.-ine one yous„„. /
selected above?
Yes
No
r/ b Date
Signature:
NOTE: (1) Application effective for one year from date of completion.
(2) If you have any questions on the above, please cal] the
office of City Clerk, Telephone 783-1100
*Financial Disclosure Form must be completed each year, prior to July 15,
by members of these Boards.
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FOR OFFICE USE ONLY:
Appointed to Board on
Term to Expire
(Date)
(Date)