HomeMy WebLinkAboutItem 09 Library Advisory Board AppointmentsAGENDA ITEM SUMMARY Meeting Date: 9/21/2015
Meeting Type: Regular Meeting Staff Contact/Dept.: Rob Everett/Library
Staff Phone No: 726-3756
Estimated Time: 5 minutes S P R I N G F I E L D
C I T Y C O U N C I L
Council Goals: Promote and Enhance
our Hometown Feel while Focusing on Livability and
Environmental Quality
ITEM TITLE: LIBRARY ADVISORY BOARD APPOINTMENTS
ACTION
REQUESTED:
Reappoint Barbara Stramler and Robyn Sattler to the Library Board with terms
expiring December 31, 2015. Appoint Kristine Fuller to complete the term of the currently open seat on the
Library Board with a term expiring December 31, 2016.
Appoint Linda Mears and Kim Thompson to the Library Board with terms
beginning January 1, 2016 and ending December 31, 2019.
ISSUE
STATEMENT:
The Library Board is seeking to fill one (1) current and four (4) upcoming
vacancies as four board position terms expire on December 31, 2015.
ATTACHMENTS: Attachment 1 – Library Board Charge
Attachment 2 – Library Board Roster
Attachment 3 – Candidate Applications
DISCUSSION/ FINANCIAL IMPACT:
The Springfield Library Advisory Board interviewed four candidates at their
September 1st regular meeting in an effort to fill a current vacancy caused by the early resignation of Gary Ross (term expires on December 31, 2016) and to fill upcoming vacancies caused by four December 31,2015 term expirations. Two
candidates withdrew before the completion of the interview process. The Board forwarded its recommendations to the Council who, following their own interviews held on September 14th, 2015 determined to make the following appointments:
reappoint Board members Barbara Stramler and Robyn Sattler to a second 4-year term (expires 12/31/2019); appoint Kristine Fuller to complete the term of the currently open seat (expires 12/31/2016); and appoint Linda Mears and Kim
Thompson to 4 year terms beginning January 1, 2016 and ending December 31, 2019.
Library Board
CHARGE
The Library Board acts in an advisory capacity for the City Manager and City Council
with respect to opinions and recommendations for future Library development, expansion of Library service, and Library policy.
Source of Existence Council/State of Oregon/Charter
Bylaws: Yes
Code: Springfield City Code, Chapter I, Article 9 Sunset Date: Council/Mandatory
Membership
Number: 7 In City: 6 Out of City: 1 – one board member may be a non-resident of the City if
an owner of real property or tangible personal property
subject to assessment and taxation situated within the
city. Term (2 max): 4 Years
Ward: No
Qualifier: Yes, 6 in City of Springfield Appointed By: Council application
Meeting Time Monthly – First Tuesday – 5:30-7:00 p.m. – City Hall
Meeting Room 3 (Except December). Funding Source: General Fund
Staff Liaison: Rob Everett, Library Director, 726-3756
Council Liaison: Sean VanGordon, Ward 1
ATTACHMENT 1
Springfield Library Board 2015
Dzierzek, Dwight (Chair-elect) ex. 12/31/17
398 N. 38th Pl.
Springfield, OR 97478
Ph. 741-0115 (home)
Ph. 541-953-2019 (cell)
dhdzierzek@gmail.com
Fehrs, Peter ex. 12/31/18
4351 Elderberry St.
Springfield, OR 97478
Ph. 503-840-4146
peterfehrs@yahoo.com
Friend, Janice ex.12/31/15
942 McKenzie Crest Dr.
Springfield, OR 97477
Ph. 541-683-7600
friendcaptioning@gmail.com
Sattler, Robyn ex.12/31/15
1133 Delrose Dr.
Springfield, OR 97477
Ph. 541-744-2787
scottrobyns@comcast.net
Stramler, Barbara (Chair) ex.12/31/15
958 McKenzie Crest Dr.
Springfield, OR 97477
Ph. 541-687-5758
stramlerb@msn.org
Stephens, Victoria ex. 12/31/15
1331 F St.
Springfield, OR 97477
(Mail to PO Box 7452, Springfield, OR 97475)
Van Gordon, Sean (Council Liaison)
2327 Clear Vue Lane
Springfield, OR 97477
Ph. 541-221-8006
seanvangordon@gmail.com
ATTACHMENT 2
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
City Manager's Office • 225 Fifth Street • Springfield, OR 97477
PLEASE NOTE:
• When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget
Committee.
• When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether
that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to
another city board, commission or committee.
• When possible, the Council will appoint people to serve on one City board, commission or committee only.
Board I Commission I Committee applying for:
Library Advisory Board
(A separate application must be completed for each board I commission I committee)
Name: Barbara A. Stramler
First Middle Initial Last
Home address: 958 McKenzie Crest Dr. Springfield 97477
Street City Zip
Mailing address: _S_a_m_e __________________________________ _
Street City Zip
Day Phone: 541--687-5758 Evening phone: _5_4_1_-9_5_4_-_9_17_8 __________ _
Email Address: stramlerb@msn.com
Preferred Form of Contact:_ Email
Do you live within the Springfield city limits? m
D
Yes
No
Ward number (City residents only): _________ _
Are you a Springfield property owner?
Are you a Springfield business owner?
Are you a registered voter? ~Yes
Yes
Yes §No
No
No
If yes, how long? ____ 9_y_e_a_r_s ___ _
Ifno, do you live inside Springfield's
Urban Growth Boundary? D YesONo
Occupation: ________________ Place of employment/School: Adult Activity Center
Adult Activity Center
Business address: ____________________________________ _
Education: 4 ears colle e
Are you currently serving on any other board, committee, or commission? If so, please list them here:
Applying for re-appointment to Library Board
How did you hear about the above vacancy? D Newspaper ad D Newspaper article D Radio/TV
D Word of mouth I./ I Board/Commission/Committee member
For more information please call the City Manager's Office 541.726.3700
D Mail notice
D Internet
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
(Over, please)
Printed on Recycled Paper
Attachment 3, Page 1 of 10
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
Please print or type:
1. What experiences I training I qualifications do you have for this particular board I commission I committee?
I have 4 years experience working on the Library Advisory Board and am its current chair.
2. What specific contribution do you hope to make?
I am the parent of 5 children who all frequent the library. We have taken advantage of many of the services the library
offers and I am familiar with most sections of the Springfield Library. This allows me to see how families can best take
advantage of what the library has to offer. I want to continue the work the board has begun in establishing a community
dialog about the need for improved library services and a new library facility.
3. Briefly describe your involvement in relevant community groups and activities. (Lack of previous involvement will not
necessarily disqualify you from consideration.)
In past years I have been involved with Camp Fire USA, and Thurston High Band parent club. I have also worked at Page
Elementary & Briggs Middle School.
4. What community topics concern you that relate to this board I commission I committee? Why do you want to become a member?
One topic that concerns me are the cuts is the cuts in funding to the Springfield School District and cuts to the libraries in
the schools. 1 feel the Library can develop programs to work with the schools. Another topic is the increase in the Hispanic
population and how the library is meeting their needs.
My family and I are regular users of the library and I would enjoy continuing my involvement w/ the board.
5. Most boards I commissions I committees meet monthly. Subcommittees may meet more frequently. Meetings generally last one
and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news
release for this position which contains the normal dates and times for these meetings and can be found at
www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee?
(!) YesQ No
Comments=~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading
statements or missing information is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my
rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I
hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV
records. I have reviewed the Advisory and meet the minimum requirements to serve/volunteer in the desired position. I also authorize to permit any materials
listed above to be copied and retained by the City of Springfield. I authorize the use of my photograph.
I will defend, indemnify and hold harmless the Oty of Springfield, its officers, employees, and agents from and against all liability or loss and against any and
all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as
a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and
expenses; except for losses, claims or actions resulting from the sole negligence of the City of Springfield.
Applicant Signature: PJ~~)\ALO ~Sb --
For more information please call the City Manager's Office 541.726.3700
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
Printed on Recycled Paper Attachment 3, Page 2 of 10
' .
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
City Manager's Office • 225 Fifth Street• Springfield, OR 97477
PLEASE NOTE:
• When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget
Committee.
• When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether
that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to
another city board, commission or committee.
• When possible, the Council will appoint people to serve on one City board, commission or committee only.
~Commission I Committee applying for:
~~~..rc,,Fte.\..D P~l<"-l-\\1~A-JZ.i 3oA:CU)
(A separate application must be completed for each board I commission I committee)
Name:~15lJJ
First
Home address: JI ~.3 l::>.S..1..KoSE-"' Street
Mailing address: (.So.""'<.)
Street
L.
Middle Initial
City
City
5Ao-T IWE. Ft,
Last
Zip
Zip
Day Phone: $1-// • 7 '-·l't • Z-7 8/ Evening phone: -----------------
Email Address: S<!J. +r V"bDJ\'\ .S@. CoW\CU.f-: V\~-r
Preferred Form of Contact:
Do you live within the Springfield city limits? ~s D No
Ward number (City residents only):--+--------
Are you a Springfield property owner?
Are you a Springfield business owner?
Are you a registered voter?
If yes, how long? / S--\f V'~
If no, do you live inside Springfield's
Urban Growth Boundary? D YesONo
Occupation:~ A-f-\\o '-<.. Place of employment/School:. ______________ _
Business address: ___________________________________ _
Education:-B~S~~E~:S:~1..-C~ti-o~_\.._O~G.;-jr------L.M--=i...rJ'-'o"--"tt..-==-----E~U&,___,,lc.L:#J=--='-$5=""-'c___------
Are you currently serving on any other board, committee, or commission? If so, please list them here:
b• 'ov-~ 'r>oa..rr.t 1 CJ>At.-1 fM;1-1 nrt-s 5c,fl.oo'-b1~+.
How did you liear about the above vacancy? D Newspaper ad D Newspaper article D Radio/TV D Mail notice
D Word of mouth ~oard/Commission/Committee member
'e~ D Internet
(Over, please)
For more information please call the City Manager's Office 541.726.3700
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
Printed on Recycled Paper
Attachment 3, Page 3 of 10
3.
4.
5.
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
Briefly describe your involvement in relevant community groups and activities. (Lack of previous involvement will not
necessarily disqualify you from consideration.) , 'I .. L _,_.. '-.."' f lo C~ ':I: ya l lf.M ~ ~ fJ\.,_ ~-c. -h-"4.J a :s; V\ ~I I 0 c..J I~ c-5 d,.;.\l.Y~ v>~ ~vc. ~""'-'~1 ; U. T al.Ao\ "/J.Jo ap.-~
1k. ~l•-hu eof\l\.~t~ ~ ~ s~l ~ ... s-tn~r vLv~ ~~r re~~ Q,..~~ +c st:M.tro \ b ~.
What community topics concern you that relate to this board I commission I committee? Why do you want to become a member? 'I ~4. Uk ~. ~v..ur-k '"tk ~'""6~ lc"t... t1"'--t'k... b ~•fin °i ~ G.\o,.AA-Q ~ ~ ~ ~ ~ ~~ ~2.~"'6·. ~
~~-<.-V... fk. -t\W\C.. (-' hJi,.q-' J__ W'nl-l~ L:~<.. -to h~ ~ \d ~
Most boards I commissions I committees meet monthly. Subco~~es m~; ::~e fi'equently. Meetings generally last one
and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news
release for this position which contains the normal dates and times for these meetings and can be found at
www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee?
~sQNo
Comments: ______________________________________________ _
I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading
statements or missing information is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my
rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I
hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV
records. I have reviewed the Advisory and meet the minimum requirements to serve/volunteer in the desired position. I also authorize to permit any materials
listed above to be copied and retained by the City of Springfield. I authorize the use of my photograph.
I will defend, indemnify and hold harmless the City of Springfield, its officers, employees, and agents from and against all liability or loss and against any and
all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as
a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and
expenses; except for losses, claims or actions resulting from the sole negligence of the City of Springfield.
Applicant Sign~ ~c;:: ~ Date:_~?_-~;?._~_7_-~(_.S __ _
For more information~ Office 541.726.3700
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
Printed on Recycled Paper
Attachment 3, Page 4 of 10
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
City Manager's Office • 225 Fifth Street• Springfield, OR 97477
PLEASE NOTE:
• When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget
Committee.
• When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether
that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to
another city board, commission or committee.
• When possible, the Council will appoint people to serve on one City board, commission or committee only.
Board I Commission I Committee applying for:
Library Board
(A separate application must be completed for each board I commission I committee)
Name: Kimberly R Thompson
First Middle Initial Last
Home address: 1550 Walnut Rd
Street
Springfield OR
City
97477
Zip
Mailing address: _s_am_e_a_s_a_b_o_v_e _______________________________ _
Street
Day Phone: 541-515-3543
Email Address: kthompson73@hotmail.com
Preferred Form of Contact: _Email
Do you live within the Springfield city limits? 0 Yes
D No
Ward number (City residents only): 2
Are you a Springfield property owner?
Are you a Springfield business owner?
Are you a registered voter? §Yes
Yes
Yes
City Zip
Evening phone: same as day phone
§No
No
No
If yes, how long? ____ 2_0~y_e_ar_s ___ _
Ifno, do you live inside Springfield's
Urban Growth Boundary? 0 YesONo
Occupation:_E_c_o_n_o_m_1_· s_t ___________ Place of employment/School: State of Oregon, Employment Researcg
State of Oregon, Employment Research Division
Business address: 1500 Valley River Rd, Suite 150 Eugene OR 97401
Education: Bachelor of Arts from University of Oregon in Spanish and Business Administration.
Are you currently serving on any other board, committee, or commission? If so, please list them here:
Willalamane Parks Foundation Board, Springfield Chamber of Commerce, and Chi Omega Sorority Corporation ID
How did you hear about the above vacancy? D Newspaper ad D Newspaper article D Radio/TV
D Word of mouth I./ I Board/Commission/Committee member
For more information please call the City Manager's Office 541.726.3700
D Mail notice
D Internet
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
(Over, please)
Printed on Recycled Paper
Attachment 3, Page 5 of 10
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
Please print or type:
1. What experiences I training I qualifications do you have for this particular board I commission I committee?
I am a long time resident of Springfield Oregon and I've been a frequent library user most of the last twenty years. I care
about sustaining this public resource. I've also been working with the Springfield Chamber and Willamalane for the last few
years because youth resources are an area of interest for me. Education is a vital part of our economic prosperity in
Springfield and library services as a part of early childhood education, which is where that process begins.
2. What specific contribution do you hope to make?
I hope to help sustain a viable public library as a energetic and dedicated community member as well as contribute to new
resources/library programs. I would like to help guide the future of our city's public resources.
3. Briefly describe your involvement in relevant community groups and activities. (Lack of previous involvement will not
necessarily disqualify you from consideration.)
I am a member of the Springfield Chamber board as well as on the executive committee for the board. I have been the
Secretary for the Willamalane Park Foundation (formerly friends of Willamalane) for the last two years. We help fund-raise
for low income youth services. I have been a mentor, advisor, and board member for the Chi Omega sorority in Eugene for
the last 10 years. At the chamber, 1 have been involved in the education, Gateway, and economic development committees.
4. What community topics concern you that relate to this board I commission I committee? Why do you want to become a member?
Maintenance of current library hours when the city budget is tight. How to keep the library relevant to community needs and
the possibility of a new library and the capital campaign needed for this endeavor.
5. Most boards I commissions I committees meet monthly. Subcommittees may meet more frequently. Meetings generally last one
and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news
release for this position which contains the normal dates and times for these meetings and can be found at
www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee?
@ YesQ No
Comments: ______________________________________________ _
I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading
statements or missing information is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my
rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I
hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV
records. I have reviewed the Advisory and meet the minimum requirements to serve/volunteer in the desired position. I also authorize to permit any materials
listed above to be copied and retained by the City of Springfield. I authorize the use of my photograph.
I will defend, indemnify and hold harmless the City of Springfield, its officers, employees, and agents from and against all liability or loss and against any and
all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as
a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and
expenses; except for losses, claims or actions resulting from the sole negligence of the City of Springfield.
• 0 Digitally signed by THOMPSON Kimberly R THOMPSON Kimberly R DN: cn=THOMPSON Kimberly R Applicant Signature: . , bate: 2015.08.24 15:58:20 -oToo· Date: 8/24/15
For more information please call the City Manager's Office 541.726.3700
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
Printed on Recycled Paper Attachment 3, Page 6 of 10
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
City Manager's Office• 225 Fifth Street• Springfield, OR 97477
PLEASE NOTE:
• When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget
Committee.·
• When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether
that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to
another city board, commission or committee.
• When possible, the Council will appoint people to serve on one City board, commission or committee only.
Board/Co~ss' n/.CMtt~applyingfor/7 _/ • D .. __ J
1. '.tltt lr~ vwrv'r&Yc ~Pl
(A separate application must be complet for each board I c 'ssion I committee)
Name:____.U-=::<l...~L....llOL'J~«-J ---~])_. ---+-&/t_.._,1&=-"-a~r-5;.=-----
Home address:___,___/ 2-_; 2-_irst_I_6Jrea __ ._f_ddl-e s;M-#--'tia-l ___,~'-P'.·'--"· ~"-"'=~;;..,....L. 1-~-~~o/_?r___.__,fl'-----
Street City Zip
Mailing address:-------------------------------
Street
DayPhon0'J() ?2{-S-5'20
City Zip
Evening phone: { 9-/() 5 ;2J-3520
I flM(J_ v-.s ~ nwcu. C0>11 Email Address:
Preferred Form of Contact: _ ~ '/
or flUM~/,~h. /Z31@yahec>.cfJvJ1
Do you live within the Springfield city limits? rg<s q Ifyes,howlong? /'f'ft;;-/°lt:/'J; 2()/( -~1f;:~ D No Ifno, do you live inside Springfield's
3 Urban Growth Boundary?
Wardnumber(Cityresidentsonly):_,,,,t._. "'--------D YesONo ~: L fruegA-er ~ ftllffkr 1v/'I() 1S. ~/; CMll•'-" Are you a Springfield property owner? l=I ~::
Are you a registered voter? ~s Are you a Springfield business owner?
Occupation: t'6J'/1/!1Ut1lr;::c/., (hts. Mgr Place of employment/School: ____________ _
Business address:._·------...,----------=-----...,,----------
Eduoati= 'BA/b/1tr.Ji/&:unuj-wduf¥t aeff / fl~Z.; JWS, ~'on ~;/
Are you currently serving on any other boar~ committee, or commissi:'iif so, please list them here:
(l/d· CttlYrfflfU./~vwzff'
How did you hear about the above vacancy?
o·Newspaper ad D Newspaper article D RadioffV
D Word of mouth D Board/Commission/Committee member
For more information please call the City Manager's Office 541.726.3700
D Mail notice
D Internet
gt~.ry
l>t5p~~
(Over, please)
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
Printed on Recycled Paper Attachment 3, Page 7 of 10
Application for a City of Springfield
Citizen Advisory Board/Commission/Committee
Please print or type:
1. What experiences I training I qualifications do you have for this particular board I commission I committee?
I have served as an information officer in the public and the private sectors for the last 18 years. Formerly, 1 was an educator in
both secondary and higher education contexts. I hold a master's degree in the field of applied information management, and 1
have served as a long-term volunteer advocate for Lane County parks and open spaces. I raised three children in Springfield,
and relied on the library and public parks for enrichment experiences for my family. And, today 1 am a caregiver for my 90-year
old mother who visits the library weekly.
2. What specific contribution do you hope to make?
1 bring long term library patron experience; my household is also bilingual. Further, I am an audience communication expert. As
the library considers new locations or new configurations to grow along with the City of Springfield, I would like to help
evaluate how all potential library audiences will be served.
3. Briefly describe your involvement in, relevant community groups and activities. (Lack of previous involvement will not
In 1991-92, I served as a volunteer communications officer for a citizen group working to pass Lane county's Ballot Measure
20-01, a charter amendment to dedicate 237 acres of the eastern portion of Alton Baker Park, Lane County's largest natural
park space, to passive recreational uses. Following the successful bond measure, I served as a member of the East Alton Baker
Park Citizens' Planning Committee, 1992-97. More recently, I am an early morning volunteer with Springfield's Egan
Warming Centers.
4. What communi~y topics concern you that relate to this board I commission I committee? Why do you want to become a member?
I am concerned with protecting and extending library access for all-seniors, children, the un-housed in our community, and
established patrons of library services. As communications manager for a regional financial institution, I depend upon a
community base of adult literacy and ESOL competency. Our public library extends literacy/ English language proficiency
through providing access to literary and cultural enrichment resources. Ramifications of the "digital divide" also concern me-
Our library plays a key role in helping all library patrons participate in society's online commons.
and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news
release for this position which contains the normal dates and times for these meetings and can be found at
www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee?
• YesQ No
Comments:~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading
statements or missing h:iformation is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my
rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I
hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV
records. I have reviewed the Advisory and meet the minimum requirements to· serve/volunteer in the desired position. I also authorize to permit any materials
listed above to be copied apd retained by the City of Springfield. I authorize the use of my photograph.
I will defend, indemnify and hold harmless the Oty of•Springfield, its officers, employees, and agents from and against ·all liability or loss and against any and
all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as
a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and
expenses; except for losses, claims or actions resulting from the sole negligence of the Oty of Springfield.
Applicant Signature: drYJ.kiJ! ·1//U_A/l(:r-Date:_<J:__./2""'--b+--/ 'ZCJ-"--(_6_ I I
For more information please call the City Manager's Office 541.726.3700
Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477
Printed on Recycled Paper Attachment 3, Page 8 of 10
Attachment 3, Page 9 of 10
Attachment 3, Page 10 of 10