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Home My WebLink AboutApplication Merritt 01/30/2014 ECEIVE, 0, PQRTN�GELEI JAN 3 1) 21,114 WAS H INGTON, U. S. A. Now APPLICATION FOR APPOINTMENT To BOARD, COMMISSION OR COMMITTEE Board,Commission or Committee to which you are seeking appointment: Applicant Name and General Information ZL) First MI Last Home Street Address City State Zip 5 6,0 Home phone Work phone Cell phone V L E-mail address Date of 13__irth- (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 Are you a citizen of the United States? Yes No Are you a Registered Voter? es No 6 Are you a City resident? (Yesi No If so,how Ion 16) Yr'� Do you own/manage a business in the City? Yes No Do you hold any professional licenses,registrations or certificates in any field? Yes 6 If so,please list: Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so,please explain: / po .......... ---- ........ .... -,-- -.................... ........ Work or Professional Experience-List most recent experience first,or attach a resume CP_5 ^<_ Employer 'Title From(M/Y) To(M/Y) Brief job description Employer Title From(M/Y) To(M/Y) Brief job description Employer Title From(M/Y) To(M/Y) Brief j ob description Education- List most recent experience first (Yes) No Institution/Location Degree eamed/Maj or area of study Gr duated? EF MS4-(?i-ew C)V",,ihov) mdao?o-+�- v5; c" I J �/Y -Wr'a Institution/Location Degree earned/Major area of study 7dinaie Yes No Institution/Location Degree earned/Major area of study Graduated? Charitable,Social and Civic Activities and Memberships-List major activities you have participated in during the last five years kuo,,,�J Organization/Location Group's purpose/objective #of members Brief description of your participation: I 5- r Organ ization/Location Group's purpose/objective #of members Brief Brief description of your participation: fe", 2 Questions Why are you interested in serving on this particular Board orCommission? What in your background or experience do you think would help you in serving on this Board? What is of the responsibilities of this oard or Commiss n? Please_ add t�4�~) Submit completed forms to: OFFICE Op THE CITY CLERK JmNESSA0[VRD,CITY CLERK 360-117-4634or'bord@cdvof6a.nu City of Port Angeles 321 E. 5t'Street P0 Box l|5O Port Angeles,VVA 98362 1n compliance with the Americans with Disabilities Act,if you need special accommodations because of a physical limitation,please contact the City Manager's Office o14l745VVno appropriate arrangements can bomade. 3 Robert M. 4515 Old Mill Road Merritt Port Angeles,WA 98362 360-477-2716 Objective Parks and Beautification board Education Western Oregon University,Monmouth Oregon BS in Physical Education Graduated in: 1992 Port Townsend High School,Port Townsend,WA High School Diploma Graduated Date: 1987 Employment 1/2004—Present Self Employed Sales Rep Clothing Oregon/Washington Territory Service 100 Customers 500,000.00 in Gross Sales 1/ 1996— 12/2003 Old Town T—Shirt Company(Owner) Florence Oregon Managed 6 employees 300,000.00 Budget 6/1992—9/1995 Parks Seasonal Caretaker City of Port Angeles,Port Angeles,WA General Maintenance Duties References Scott Brodhun Assistant to City Manager Petaluma,CA 94592 (707-772-6025 Rian Anderson Black Ball Ferry Line VP of Terminal Operations (360-460-8920 Dave Flodstrorn Nippon Paper(Retired Human Resources Manager (360-452-9964)