HomeMy WebLinkAboutPriebeMatthew Affidavit Disclosure 2010 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
I �4f ew �� C make the following disclosure under oath:
(Name)
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
1. o ❑ 1 am an ❑ elected or ❑ appointed q officer orpi employee of the City of-
Lansing holding the osition of V. (<<� 09%f" in the
L Qn C n v YG f Cf_ department
❑ 1 am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named ,
holding the position of in the
department.
❑ I am a Business Associate of an elected or appointed officer or employee
of the City of Lansing named
Holding the position of in the
Department.
2. ❑ 1 may derive income or benefit directly from a contract with the City or from
any City action detailed below. (Charter 5-505.1)
❑ I may have a conflict between a personal interest and the public interest,
the nature of which is disclosed below (Charter 5-505.2) [Chapter
#290.04(1) of the Code of Ordinances]
❑ 1❑ I may have a financial interest in a matter proposed to be acted upon by
the City of Lansing as described below [Chapter 290.04(1) of the Code of
Ordinances]
t� ❑ 1 make this disclosure because of a possible appearance that I may be in
violation of or in conflict with the City of Lansing Ethics Ordinance as
provided for in the Code or Ordinances and in the City Charter
3. This position is: ❑ Full time mart time (less than 25 hours/wk) ❑ Unpaid
4. My Address is:
5. My Business (daytime) Phone# is:
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
DISCLOSURE ANDt EXPLAIN WHY YOU THINK A/ CONFLICT MAY/MAY NOT EXIST.
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I hereby certify that this disclosure is complete and accurate to the best of my knowledge,
information and belief.
The foregoing Affidavit of Disclosure was executed on this Z day of
'364— 20 !O
Signed.
State of Michigan, County of 0'\Y ll n
Subscribed and sworn to before me this Z• day of 20 / b
JODIE E.GEOR51 Notary Public%r Deputy Clerk
Notary Public,State of M1 i n i VI A L, County, Michigan
County of Clinton (r�
My Commission Expires Aug. 1,2012 My Commission Expires:
Acting in the County of G \ �
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 11-05-04
ATTACHMENT A
Please provide additional information about your outside business or
employment. Of special interest to the Board is how the activities of the business
or employment may directly or indirectly affect the City. This disclosure is about
information and is not an indication of any anticipated conflict of interest or
suspected wrongdoing. Therefore, please describe for the Board what it is you
actually do and be detailed and specific. You are not required to limit your
disclosure only to the following questions. For each business, include in your
answer such things as:
• What is the form of your business entity and
s�what percentage do you
own?
• Are you self-employed? /�f
■ Who is your employer, if applicable?
• What are the things you actually do in the business? /����
has;� p Ao
SdT�� and J/�nI'de F!� , e /?e/font/ C(C._' e
4j Cvri7�ei,
• Who are your clients) and who receives your goods or services? L {eEc
Io re1��o/9fi�/P ,. �h,�;nq /A �4 (f c %Le<,1
2_ 1 &z ,J4
• How and where are your services performed?
C �aSSroot�l � ' Lcn ('GviyPl Qr�� �Or�1 ,
Page 1 of 3
■ How often do you do outside /work? 2�
2-/Y Aourf Jtn vi/FG J C '21fe f
• Do/es your /business or employer contract with. the City?
Sly CIS' lej
• In performing your business
or outside employment, do you use any City
facilities or equipment? If so, describe:
• Is any of your business o/ l
r�employment conducted in the City? Y1 If so,
describe: SDofc o 1 lxe Rl- vu�&
0h� C/CitSlby/'J
■ Does your business advertisement or circulars, if any,, contain any
referrenceff to the City or your City employment? ✓v.�im we_ 6-e
• If your business uses advertisements, circulars, applications, or order
forms that you have designed or have had designed for you, please attach
a copy of the applicable form(s).
Page 2 of 3
• If you provide training or education as part of your business:
Do you identify yourself to your clients or students as being employed by
the City of Lansing? 0^jam ? aSe4
}71�J2�t" Gi-I Gam. C2rT1 e�i tns �vza.c-(ar ` lro�q /
-I f1e i!/ii-. y roN�� �J-"t-�e �JfUC=yt TtOr7 .
Do you include in any of the written materials or aids or reference in any
way in your presentations reference to policies, procedures, methods or
materials as being those also used by the City of Lansing? ///0 If so,
attach a copy of the material or aid and explain the reference in your
presentation.
• Is there any additional information that you believe would assist the Ethics
Board in its review of your business or personal activities for potential
conflicts of interest? /VO If so, please describe:
In providing this additional information, the Board of Ethics asks that you give
special attention to the Conflicts of Interest section of the Charter found at 5-
505.1- 5-505.3. A copy is enclosed for your convenience.
Page 3 of 3
Revised 10-20-03
City of Lansing
Personnel Services Department
FOP JOB DESCRIPTIONS
Department: Police
Job Title: Police Officer I Job Code: 1450
EDUCATION & EXTERIENCE REQUIREMENTS: High School Diploma or GED and completion of ninety
(90) term or sixty (60) semester hours of college level course work. (In some cases, fifty-three(53) term or thirty-
six (36) semester credits is acceptable.) Major credits in Law Enforcement are desirable. Must possess and
maintain a valid driver's license.
SPECIAL REQUIRE,ME
I.MUST BE AVAILABLE TO WORK NIGHTS,WE, HOLIDAYS AND ON AN
OVERTIME BASIS.
2.Must be twenty-one(21)years of age on date of appointment
3.Must be a citizen of the United States of America
4.Must possess a valid Michigan Driver's License at time of employment and possess a satisfactory driving
record.
5.Must not have pending,or have been convicted of any felony
charges and pass a criminal history record check.
6.Must meet physical standards as determined by the City's Medical Director.
REOUIRED KNOWLEDGE, SKILLS & ABILITIES: Knowledge of modem principles, practices and
procedures of police work, Skill driving vehicles and in using firearms in accordance with established guidelines.
Skill in writing reports and maintaining records and files. Skill in making arrests. Ability to understand and follow
verbal and written instructions. Ability to use a personal computer with basic keyboarding skills. Ability to
remember names, faces and details of incidents. Ability to establish and maintain effective working relationships
with co-workers, other City employees, governmental officials and the general public. Ability to properly retain
and dispense confidential information.
ESSENTIAL JOB FUNCTIONS: (Reasonable accommodations will be provided,if necessary,for individuals
with disabilities who can perform the essential job functions.)
-Performs wide range of duties to protect citizens and enforce laws in the City.
- Conducts patrols and performs other related duties in assigned area while driving an automobile, motor
cycle or other vehicles exercising special care when driving in emergency situations.
-Responds to calls for assistance in the community, interviews witnesses and other individuals regarding
incidents and uses interpersonal and necessary enforcement skills to maintain order and resolve conflicts.
- Monitors, receives and transmits information on a radio and over the phone which requires excellent
listening and speaking abilities.
- Loads, unloads, aims and fires handguns, shotguns and other firearms from a variety of positions for
training and in positions that justify the use of deadly force.
Police Officer I Pg. 2
ESSENTIAL JOB FUNCTIONS CONT:
- Provides a wide range of information and other services both verbally and in writing to citizens in the
community.
-Reads and comprehends rules,regulations,policies,procedures and other documentation to ensure needed
knowledge is acquired and retained regarding law enforcement activities.
- Prepares legible, hand written, investigative and other reports including sketches which are accurate and
complete.
-Progresses to report writing utilizing a personal computer which requires basic keyboarding skills.
-Conducts physical searches of persons and sites to detect potential weapons and contraband.
-Provides testimony in court regarding work activities.
Examples of job functions listed do not include all tasks which may be found in this position. Duties and
responsibilities may be added,deleted or modified at any time.
PHYSICAL CAPACITY REQUIREMENTS: Standing,walking,running,lifting,pulling,pushing,hearing,
listening,speaking,twisting,turning,bending,crouching and visual acuity.
ENVIRONMENTAL CONDITIONS: Primarily an outside position with exposure to all types of weather
conditions. Involves extensive driving including in emergency situations and exposure to a wide range of potential
hazards while conducting law enforcement duties.