HomeMy WebLinkAboutApplication 8/14/2015 D E�
GRT NGEL,EI AUG 14 2016 �
r , w A s H i N G r o N, U. S. A. QTY OF PORT ANGELES
® CITY CLERK
APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE
Board, Commission or Committee to which you are seeking appointment:
Lodging Tax Advisory Committee (LTAC)
Applicant Name and General Information
Michael S. Edwards
First MI Last
3403 E Masters Rd
Home Street Address
Port Angeles WA 98362
City State Zip
360 457-4880 425 503-2035
Home phone Work phone Cell phone
mikeedwards-1 @hotmail.com
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 o
Are you a citizen of the United States? es No
Are you a Registered Voter? Ye No
Are you a City resident? Ye No
If so,how long Q
Do you own/manage a business in the City? Yes
Do you hold any professional licenses,registrations or certificates in any field? No
If so,please list: t C_bkS� VC-C-
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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
Empl4er Title From(M/Y) To(M/Y)
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Briefjob description
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Employer Title From(M/Y) To(M/Y)
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BriJfjob description
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Employer t Title From(M/Y) To(M/Y)
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Brief job description
Education - List most recent experience first
0 S I OJ es No
Institution/Location Degrie earned/Major area of st y Graduated?
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Institution/Location Degree earned/Major area of study Graduated?
A A 401 No
Institution/Location -Deg-11 earned/Major area of study' Graduated?
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Charitable, Social and Civic Activities and Memberships -List major activities you have participated in
during the last five years
Organization/Location Group's purpose/objective #of members
Brief description of your participation: V t---& L3(-T 4-+ c. j N A
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Organ ization/Locati6n Group's purpose/objective of members
Brief description of your participation: A , �Fc, L:T-A(-
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Questions
Why are you interested iuserving on this particular Board or Commission?
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What in your background or experience do you think would help you in serving on this Board?
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What iayour understanding of the responsibilities ofthis particular Board o,Commission?
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Please feel free to add any additional comments you wish to make regarding your application.
Appli t I Signature Date
Submit completed forms to: OFFICE 0pTHE C:ry CLERK
JENNIFER VENEKLASEN,CITY CLERK
360-417'4634ur'vunek\u@cityofpa.ua
City ofPort Angeles
32| E. 5th 8kcot
P8 Box }/50
Port Angeles, VV/\ 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.
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