HomeMy WebLinkAboutApplication Prater 06/02/2013 K
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APPLICATION FOR APPOINTMENT To BOARD, COMMISSION OR COMMITTEE
Board, tarnmissican or Committee to which you are seeking appointment
a icaant acne and General InfCarnatatacan �.. . _...
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l�irst l�il Last
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_ �lraaa -;el Acldo•ess
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City Stag. lips
�fjoi e Phone ')rk prlacaaae Cell phone
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Date of Birth (t�ube completed only by applicants for � ._.. ........
Public Safety Advisory Board far purposes of criminal
history Check to ensure c.ompali;ance with Port Angeles Municipil Code 2.26.020)
Certification and Location Information (circle acme:)
Are you employed by the City of Port Angeles? Yes NK
Are you a citizen of the United States' � No
Are lfscaYlaca�a� laa�y resident? c1
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_ �....... _..—— �. _.__. ... .. ..... —-------
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Do you own/manage a business in the City? Yes b"
Do you hold any larofesssional licenses,registrations or certif7c" ws in any field? No
lfso, please dish �� ,� ~�w ��" �
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Are you aware of any confIlict of interest which might arise by your service on a City Board or Coannission? I f'so,please
explain:
Work or Professional Ex erience - List most recent experience First,or attach a resume
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U�E-1!31 0 y e r 'Fitle V I-OT11(M/Y)
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job desc��,,;�i', i
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Employer To{M/Y)
9-r ...........................Job description
............................ .......
Employer Title Froni(M/Y) To(M/Y)
BriefJob description
Edneation - List most recent experience first
No--
Institution/Location D,egr e earned/Major area of study adnlated?
"Yes No
I list itution/Locati on Degree earned/y CIor area of study Graduated?
Yes No
Institution/Location Degree earned/Major-area of study Graduated?
Charitable, Social and Civic Activities and Memberships - List major activities You have participated ill
dUrino the last rive years
zation/Location Group's pUrpose/objective 4 of members
Brief description Of your PRI-ficipation.___
.................. .......... .....................................
...............—.......... ........ ........ .............................................................................................................
Organization/Location Groups purpose/objective 4 of iliembers
Brief description of your participation:,_ ——-—------
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Questions
are you rrttereste r crving on this particular Board ur C ornmissrt
What in your background or experience do you think would help YOU in serving on this Board?
.. . ..
What is your understanding of the responsibilities of this particular Board or Cnaimission?
Please feel free to add any additional comments you wish to make,regarding your application,
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" l p a1i q"a1It Sigilaft °e at
Submit completed forms to: Cat pIt,r 01, THE,CITY MANACE'R
Tt;tttr.'. PIERCE,DEPt TYCat"tl Ct,tt;R
60-417-4630 or tpierce @cityo paa.us
City of°Port Angeles
321 P. 5"r, Street
PCB Box 1150
Pam Angeles, WA 98362
In compliance with the Americans with Disabilities Act, if yotr need special accommodations because of'a physical
limitation,please contact fire City Manager's Office at 417.4500 so appampariate arrangements can be made.