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� S/U�7PLE <br />'�A"1'EA2EI�ET QF AVAILABILITY FOR aPPOIe�IT�1Fri'I' �'0 CiTY QF R05EVILLE <br />�' <br />BOAIZDS AND CQi.1�IISSIONS <br />Date <br />_ f <br />�r�-1��: <br />Submitted to: City Counci.l via City �,�r?�'s Office <br />For consideration of appozntment to <br />(Name of Board or Coinmission) <br />Name A�e <br />Home Address Phone <br />Employment <br />Employment Addxess <br />Length af residence in City <br />Past CQ��nunity Servic� : <br />Othex qualificat�ons: <br />Camments: <br />Phone <br />It is understood that this appoantment <br />may be discussed ati a public meeting. <br />(Si�nature) <br />