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2. Select the Board, Commission, or Committee applying for:*
   -- Select One --Select OneBoard of Adjustment and AppealsEconomic Development CorporationParks and Recreation BoardPlanning and Zoning CommissionCDC 4B CommitteeKeep Little Elm BeautifulTIRZ #1TIRZ #2LERACharter Review Committee
4. Personal Information
6. Name:*
7. Home Phone Number:*
9. Address:*
10. Business Phone Number:*
12. Length of Residency*
14. Occupation:*
16. Email Address:
18. Education and Hobbies
20. High School:
22. College:
24. Trade or Business School:
26. Hobbies:
28. Organization Membership Information
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34. Please list organization memberships and positions held:
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44. Please List Areas of Special Interest
46. Please Enter Basic Resume Information Below
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50. If appointed, do you give permission to the Town of Little Elm to post your name on the town website?

    
    

    1. Yes
    2. No
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54. If appointed, do you give permission to the Town of Little Elm to post any personal information required by the Open Records Act?

    
    

    1. Yes
    2. No
56. If appointed, do you give permission to the Town of Little Elm to post your biographical information on the Town website?

    
    

    1. Yes
    2. No
58. If appointed, do you agree to dedicate the time necessary to fulfill you commitment to such board or commission?

    1. Yes
    2. No
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62. If appointed, do you agree to abide by the Town of Little Elm’s Charter, Code of Ordinances, and Town Policies and Procedures?

    1. Yes
    2. No
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66. The Town of Little Elm recognizes and supports the concept of balanced representation in regard to filling vacancies on boards and commissions. To this end, every effort is made to appoint members who represent our diverse community, including citizens of all ethnic groups, from varied geographic areas of town, with specific background experience in the area of interest, and who will dedicate time required to fulfill their board responsibilities, and who reside inside the corporate town limits (unless otherwise approved for ex-officio status).
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70. Have you ever been a member of a Little Elm board or commission before? If so, please indicate the board or commission and the approximate dates of service:
    
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74. What experience do you have that you believe qualifies you for service on this board or commissions
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78. What civic or community endeavors have you been involved in?
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84. What is your current place of employment or business affiliation? If you are self- employed, a homemaker, or not employed, please indicate. Also, describe briefly the nature of your current employment (i.e. manager, partner, associate, clerk, etc.).
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88. What is your spouse's current place of employment or business affiliation? If your spouse is self-employed, a homemaker, or not employed, please indicate. Also, describe briefly the nature of your spouse's current employment.
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92. Do you or your spouse, either individually or through your employers, have any financial interest, directly or indirectly, in any contract or subcontract with the Town or in the sale to the Town of land, materials, supplies or services? If so, list below:
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98. Are you or your spouse, either individually or on behalf of a business entity, involved in any pending bids, proposals or negotiations in connection with a Town contract? If so, list below and explain:
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104. Do you or your spouse, either individually or through your employers, have any pending claims against the Town? If so, list below:
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108. Do you represent the private interests of others in litigation or a claim to which the Town or an employee of the Town is a party? If so, list below:
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114. In which geographic area of Town do you reside?

     1. North
     2. South
     3. East
     4. West
     5. Downtown
116. 
     
118. Are you a registered voter?

     1. Yes
     2. No
120. 
     
122. Are you a Town of Little Elm resident?

     1. Yes
     2. No
124. Do you owe any funds or taxes to the Town of Little Elm?

     1. Yes
     2. No
126. Do you or your employer have any business deaings with the Town of Little Elm.

     1. Yes
     2. No
128. 
     
130. If you answered “yes,” to the prior question please elaborate.
     
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134. Are you currently appointed to another Town board or commission?
     
     

     1. Yes
     2. No
136. Are you related to anyone who is appointed to Town board or commission?

     1. Yes
     2. No
138. Are you related to an employee of the Town of Little Elm?

     1. Yes
     2. No
140. Are you related to an elected official of the Town of Little Elm?

     1. Yes
     2. No
142. Describe any qualifications, expertise, or special interests that relate to your possible appointment.
144. 
     
146. It is suggested you submit a cover letter and resume with your application. Please return the original to the Office of the Town Secretary for processing. You may wish to contact the City Council assistants to schedule an appointment with a Council Member to discuss your application.

     Your application, which is public information under the Texas Public Information Act, will be kept on file for twelve (12) months.

     If appointed, information on this application will be on the Town’s Website located at www.littleelmtx.us
     *** ADA COMPLIANCE ***
     Reasonable accommodations and equal access to communication are provided upon request.

     
     Return to: Town of Little Elm
     Office of the Town Secretary
     100 West Eldorado, Little Elm, Texas 75068
     Phone: (214) 975-0404 - Fax: (972) 377-5540
     e-mail: kphillips@littleelm.org
     
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158. AUTHORIZATION TO RELEASE INFORMATION FORM
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164. Supplement to Application for Voluntary Service

     Thank you for your interest in servicing your community. As part of the application process, we need your authorization to review your background information. Please read, sign and date this authorization.

     I hereby request and authorize you to furnish the Town of Little Elm with any and all information that they may request concerning my work record, educational history, military record, criminal record and general reputation. This authorization is specifically intended to include any and all information of a confidential or privileged nature as well as photocopies of such documents, if requested. The information will be used for the purpose of determining my eligibility for volunteer service with the Town of Little Elm.

     I hereby release you and your organization from any liability, which may or could result from furnishing the information requested above or from any subsequent use of such information in determining my qualifications for employment.

     
     
166. 
     
168. Applicant's Signature
170. Date:
172. 
     
174. Note: This form may be retained in your files.
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184. CRIMINAL RECORD CHECK RELEASE FORM
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188. Name:
190. Drivers License Number:
192. DOB
194. Sex
196. Race
198. I hereby authorize the Town of Little Elm to conduct police record inquiries to determine my acceptability for volunteer service.

     
     
200. Applicant's Signature:
202. Date:
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206. 
     
208. FOR OFFICE USE ONLY
210. Cleared Criminal Record Clerk
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214. 
     
216. Date Cleared:
218. 
     
220. Date Sent:
Leave This Blank:


222. Submit

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