HomeMy WebLinkAboutRutten AppD
AppLrcATroN FoR APPOINTMENT TO BOARD, cOVrrvlSSrON On COUUlrrrn
GELES
E Efl V Itr
APR I I 2s;7
W A S H I N G T O N. U. S, A NGqK LES
Board, Commission or Committee to which you are seeking aPpointment:
Applicant Name and General Information
e-ru-
Firsl
c-fT5at-,
\{I Last
23 € brh
Horysi-SEGe\Addrcss" l)r- + A-€(es a
State Zip
G l-L
Home phone
Cizs
Work phone Cell phone
Ao)^n 0ec c- U,le, C-er rrt
E-mail address
.f lo 111
Date of Birth
Certification and Location Information (circle ooe)
Are you anployed by the City of Port Angeles?
Are you a citizen ofthe United States?
Are you a Registered voter?
Are you a City resident?
(to be completed only by applicants for Public Safety Advisory Board for purposes o{ crimitrll
history check to ensure complirtrce liith Port Angeles Municipal Code 2.26.020)
Yes
@
qe/
No
No
No
Ifso. how I 2q rS
Do you o*.r/manage a business in the City?
Do you hold any Fofessional licenses, registratioDs or certificatcs in any field?
Yes
/--7-..\t',1,
No
Ifso, please lis:
-?.ossas
.C
aC /rers
CITY OF
G\:
YC J!-{
City
@
I
@
Are you aware ofany conflict ofinterest which might arise by your s€rvice on a City Board or Commission? lfso, please
explain:
Crescerl-f SJ"..t O;s-r Pr*.-t
Employer Title From (M,Y) To (M/Y)
Gv.onr - Coa Li h "t &-"t; n41,',,
Briefjob description
loyer
<_ In
Title
.,c{z\ tqSO -e**
From (M,^/) To (M/Y)
a&.Lt c,{is{, S {<^ Ji. e s
Briefjob description
Employer Title From (MAr) To (M/Y)
Briefjob description
ldUgation - List mosl recent experience first
d<ni,lS.r(^ Co/(-c<-tlt{ /U,..^a (-,v,c;6x
Institution/l -ocation @ GEuated?
Degee eamed/Major area ofstudy Graduated?
Yes No
Institutior/Location Degree eamed/Major area of sludy Craduated?
Charitablg Social and Civic Activities and Memberships - List major activiti€s you have participatcd in
during the last five ycars
So-.o,lti o1i:r s+et V* Lx-,6111p", [.Gir;". U]ror,n--,- q\-
@
Brief description of your panicipation:t)
k i-r,-, C\."r-Cor," nr u-^.i4- \-, ..--
Organization/Location
Brief description of your participation:
c-rp.spr,"ose/.bjec[ve
)
C.(1a! &- -
# ofmembers
3s-
Work or Professional Experience - List most recent experience first, or attach a resume
la- iG
(
€L,r.,ro-lor^- S+^{e- 6g Soc-rolcr",.-r c€ no
lnstitutior/ location
Questions
you interested in s€rving on this particular Board or Commission?
a-
<'-
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 Commission?
Please feel free to add any additional comments you wish to make regarding your application.
C-e-+:, c
Applicant ture
Submit eompleted forms to:OFFICE oF THE CITY CLERK
JENNIFER VENEKLASEN, CITY CLERI(
360417 4634 or jvenekla@cityofpa.us
City ofPort Angeles
321 E. 5t Street
Port Angeles, WA 98362
In compliance with the Americans with Disabilities Act, ifyou need special accommodations because ofa physical
limitation, please cootact the City Manager's Office at 417.4500 so appropriate arrangements can be made.
3
I