Date
NAME:
ADDRESS: Zip
TELEPHONE NO.: (Work) (Home)
EMAIL ADDRESS: DISTRICT:
YOU MUST HAVE YOU LIVED IN CENTENNIAL FOR AT LEAST A YEAR IMMEDIATELY PRECEDING APPOINTMENT TO THIS COMMISSION.
(CMC §2-6-10 (b) (2))
Please initial in acknowledgment of the above statement.
1. Please initial next to all of the following that apply to you: (CMC §2-6-10 (b))
a) Have you previously, or do you currently have plans to run for elective
office in the City of Centennial?
b) Are you related to anyone who plans to run for elective office in the
City of Centennial? If so, who?
c) Are you an organizer, member, officer or registered agent of a
candidate committee, issue committee or other political organization?
If so, would you be willing to resign your position prior to appointment
to the Election Commission?
Yes No
2. Are you currently serving on a Centennial Board/Commission/Authority?
3. Are you a City employee, employee of a contractor to the City, or related
to a City employee or employee of a contractor to the City?
If yes, please state name(s) and relationship:
4. Describe why you would like to serve on the Centennial Election Commission?
5. What knowledge do you have of Colorado Election Laws?
6. What skills and abilities will you bring to the Commission?
7. Describe your educational background.
8. Please list any business, professional or general experience that would be
helpful to this commission:
8. Are you available the 4th Tuesday evenings of each month?
Is there a night of the week that you have a regular conflict?
Would you be available for additional meetings if needed?
Signature:
Date:
FOR OFFICE USE ONLY:
Date Received: Received by:
Interview Date:
Comments:
Return to: City Clerk, City of Centennial, 13133 E. Arapahoe Rd.
Centennial, CO 80112 no later than 5:00 p.m. June 4, 2010.
