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Home My WebLink AboutApplication Graf 10/03/2013 D ECC AYE no 3 2013 •.r was � � rvara [v, u. s. a. a. Gi7Y O I'f QCI_ K �E APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: "x�eL' -f A0V L5C712W ( Ae o Applicant Name and General Information First MI Last Horne Street Address - � City State zip Home phone Work phone Cell phone E-mail address Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Yes I o Are you a citizen of the United States? Ye No Are you a Registered Voter? 'es No Are you a City resident? p Yes (KO) If so,how long , I Do you own/manage a business in the City? es No Do you hold any professional licenses,registrations or certificates in any field? Yes No If so,please list: e= ---- 1 Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so,please explain: Work or Professional Experience- List most recent experience first,or attach a resume Employer Title From(MIY) To(M/Y) LJc cif Ltri-i i Q-n-uft :. -4 Coco s wxS��f G TvA, PVS(?, H o Brief job description Employer Title From(M/Y) To(M/Y) Brief job description Employer Title From(MIY) To(MIY) Brief job description Education - List most recent experience first SG•C 4 I C)k(::O &"L.i u �,ct � �G�` 60! PtST (YQ6 No +In�stitution/Location Degree eatned/Major area of study Graduated? VvrUC VIC"� �G` tl24 �. �M ( caviiiLt t Yes No Institution/Location Degree earned//M�aj or area of study ra uated? t ur�C �1_+�ti te°rfiLuallrrl ? t 4Li1�xC - t_4ra,'T Yes No Institution/Location Degree earned/Maj or area of study raduated? Charitable, Social and Civic Activities and Memberships -List major activities you have participated in during the last five years P1 mov,-tp) L01; op aovu bycLFT- �^ Organization/Location Group's purpose/objective #of members s Brief description of your participation: s c nQ L-0 rA Ur, New tiAvne p QL;wVD(% LJL-. Irk P\) Organization/Location Group's purpose/objective #of members Brief description of your participation: IP P-- P,&O, tc( p 2._. 't4=, t. � Za' `-�er7-y2z 2 Questions Why are you interested in serving on this particular Board or Commission? 4N "I'1 j,2-� c7q-- 'V,V�-- What in your background or experience do you think would help you in serving on this Board? C r y O K5YD °-t s Cn,5t—, 1°d r94,r ct- rcqe 7 uv riv c i� , .�rnr PAL,(du_ cv ; v+ 4 � What is your understanding of the responsibilities of this particular Board or Commission? O t Please feel free to add any additional comments you wish to make regarding your application. g L-C (Acy Q)A"S WN G��aL°5 f.l t�c_f3 L4. -;tf:C"e ocor" Kra -Cr4tzVY7 co t �6 App scant Signature Date Submit completed forms to: OFFICE OF THE CITY MANAGER TERESA PIERCE,DEPUTY CITY CLERK 360-41.7-4630 or tpiercc @cityofpa.us City of Port Angeles 321 E. Sri' Street PO Box 1150 Port Angeles,WA 98362 In compliance with the Americans with Disabilities.Act,if you need special accommodations because of a physical limitation,please contact the City Manager's Office at 417.4500 so appropriate arrangements can be made. 3 FIREARMS TRAINING SIGSAUER ACADEMY 101 Band Gun Orientation—Basic Firearms Safety Course for Handgun Owners—Todd Horn 102 Basic Practical Pistol Skills—Todd Horn Low Light Pistor Operator—Chris Cavallaro Concealed Carry Pistol—Todd Horn Close Quarter Pistol Operator 556 Operator Course—Todd Horn Reflexive Shooting--Scott Herringson Bullets and Bandages—Kerry Davis Bullets and Vehicles—Kerry Davis Executive Protection Operations—Tire Arnold Civilian Response to Terrorist Attacks—Todd Rassa Force-On-Force Response to the Active Shooter for the Concerned Citizen—Todd Rassa Civilian Response to Terrorist Attacks—Force-on-Farce--Todd Rassa Preparation for Social Collapse—Todd Rassa Advance Social Collapse—Todd Rassa GUNSITE ACADEMY Precision Rifle 7—Corry THE FIREARMS ACADMENY OF SEATTLE, INC Weeklong Handgun—Marty Hayes EDUCATION University of Arizona —Bachelor of Science A q 4 S License Massage Practitioner- Peninsula College 111R Certified in Craniosacral—Milne Institute, Big Sur, CA X00 �- Certified in Medical Qi Gong—China l�j(' Certified Nutritional Therapist (now a Nutritional Therapist Practitioner) Lifestyle Educator--Metagenics Inc. '�.c2(b