5.1. SR 04-12-2010'1~ //
Elk REQUEST FOR ACTION
River
To Item Number
Ci Council
Agenda Section Meeting Date Prepared by
Worksession Apri112, 2010 Jessica Miller, Executive
Secre /De u Ci Clerk
Item Description Reviewed by
Interview Parks and Recreation Commission Applicant Tina Allard, Ci Clerk
Reviewed by
Lori ohnson, Ci Administrator
Action Requested
Interview Andrew Karlsen for consideration as Parks and Recreation Commissioner. If appointed, term
expiration would be February 28, 2013.
Background/Discussion
There is one vacancy on the Parks and Recreation Commission. Mr. Karlsen will be in attendance at the
Apri112, 2010, meeting.
Financial Impact
N/A
Attachments
^ Application
Action Motion by Second by Vote
Follow Up
S:\Public Bodies\Boazds\Council Memos\2010\Karlsen.doc
APPLICATION FOR APPOINTMENT TO CITY
ADVISORY BOARDICOMMISSION
'`"''`'`''' ''~~ Terms beginning in March
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Thank you fox your interest in serving your community! Please indicate in order of preference on
which of the following boards and commissions you axe interested in serving with 1 indicating your
first choice, 2 your second choice, and 3 your third choice.
Education/Professional Experience: Describe your educational and professional experience or
skills that qualify you tQ serve on this bo~d/commission.
~h le, of s"c ho,~ / ~~ ~~ .•_ ~. r•a ~J a .f:'s• h- ~' c• u.~ •! ~ r,. / -fl`u h -•~
~ Energy City Commission
~ Heritage Preservation Commission
Ice Arena Commission
Parks and Recreation Commission
Planning Commission
Utilities Commission
All terms are three years and begin on the first day of March. See the specific board and commission
description for additional information.
APPLICANT INFORMATION
Name: ~~iu~/e k/ ~~ /• ~s• ~ h
City of Residence: E~/~ ~r•~'' ~'/`
Occupation: ~ ~~ ~/' ~ ~- ./ Employer:
Statement of Interest: Please state briefly why you are interested in serving on this
board/commission for which you are submitting this application. /l
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Relevant Personal/Professional Experience: Please describe your professional, civic, or
community participation, which may be relevant in serving on this board/com 'ssion.
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Attendance: Are your aware of the importance of regular meeting attendance including the time
commitment involved in preparing for meetings, and do you feel you have the time available to be
an active participant? Yes ^ No
Comments: ~ re s !A ~a /~
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Conflict of Interest is defined as the participation in any activity, reconunended action, or decision
from which the individual has or could have the potential to receive personal gain, whether it be
direct or indirect. (See attached "Conflict of Interest" Ordinance)
In accordance with this definition, do you have any legal or equitable interest in any business,
however organized, which could be construed as a conflict of interest? ^ Yes ~ No
If yes, provide details on a se arate iece of a er
.~ •Us` •i;o/a
Applicant Signature Date
Questions may be directed to the Administration Department at 763.635.1000.
OFFICE USE ONLY
The Applicant is: ^ New Applicant ^ Applying for Reappointment
Council Action:
^ Not Appointed
^ Appointed to: _
Date Appointed:
Term Expires: _