PLI app final PLI of Polk 2.0 2019 proposed application (fillabl | Page 4

8. Have you ever been convicted, pled nolo contendere (no contest), been placed on probation, fined, entered a pre-trial intervention program or had adjudication withheld by any judicial or quasi-judicial body for any felony or misdemeanor other than minor traffic violations? 9. If invited to participate in the program, do you understand that full attendance during all four sessions of the entire Leaders School is mandatory for acceptance into the program? Yes No 10. What is your registered political affiliation? Democrat Republican No party affiliation Not registered to vote identify): _______________________________________ other (please 11. In what year did you register to vote at your current residence? _______ In what year did you first register to vote? _______ 12. Has your employer agreed to give you time off work to attend the sessions should you be chosen to participate? Yes No My employer has questions. Would a PLI director please contact me. 13. Is there other information that you would like to share with the selection committee, particularly as it demonstrates your commitment to public service, community involvement and leadership? 14. Please provide the names, including title and place of employment, and contact information, (email and telephone number) for at least three (3) personal or professional references. DEADLINE: Friday, April 19, 2019 In your email submission, please include an up-to-date biography, CV or resume that contains complete and up-to-date employment history and education, and photo. To submit application or for questions, please contact Cory Skeates, President, Lakeland Area Chamber of Commerce, [phone] [email protected]