HomeMy WebLinkAboutKrout Application 01/17/2018 '........m...........
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JAN 7 2018
The City of Para Angeles �a �. m .. .�..W ��... �L0
A lication for A ointment to Board Cod �rsslon a►r Ci r
it ee
Board,Commission or Committee to which you are seeking appointment:
,applicant lame and General Information
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First MI Last
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Address City State Zip
Home phone Work phone Cell phone
E-mail address
Certification and Location Information (circle one)
Are you employed by the City of Port Angeles?_______ ................ ........... .,_........ Yes No
Are you a citizen of the United States?.µ.........._._ ..,, .... ....,.. ....,......_......................................___.m..........................4ZY es No
Are you a Registered Votcr?,,.. _......._.,._......_.w.... .,.... _, ,...M. ......................................................1
. Ye No
Areyou a City resident ........_.._.._...................._..._..,...,_..,.._.,,,_.,................._,,.........,_.....,....._....,,,,.,., "des l No
If so,how long: Ll L� C a
Do you oum/ manage a business in the City?._...........m.,..,,_.. .,,..._..................n....... ----- ................................ ............... -,,--,,,Yes
Do you hold any professional licenses,registrations or certificates in any l"zeld?...._....,......®.._--_-- No
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If so,.please list: l f t ...mt t '� lel�w;;.
Are you aware of any conflict of interest which might arise by your service on the advisory board that you are applying for?
If so,please explain:
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Work or Professional Experience- List most recent experience first, or attach a resume
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Employer
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Brief job descrip n
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Employer
Brief job description
Employer 0
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Brief job description
Education-List most recent exile 'rest
Yes CS;l
Institution/Location Degree earned/Major area of Study Graduated?
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Institution/Location Degree earned/Major 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 in
during the last five years
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Organization/Location Group's purpose/objective
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Brief description of your participation:
Organization/Location Group's purpose/objective
Brief description of your participation:
Submit completed forms to: Office of the City Clerk Jennifer Veneklasen
City of Port Angeles 360-417-4634
321 East 5"Street j-%renekla@cityofpa.us
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 360417-4500 so appropriate arrangements can be made.
This document and all attached information is considered a public record and may he distributed to members of the City Council
for appointment consideration. Additionally,it may become a part of a City Council packet.
L This Commission focuses on three areas: parks, recreation, and beautification. If you had to
choose,which of these three areas would be the primary one in which your interests and
experience would be aimed? T
2. What is your favorite City of Port Angeles parks and recreation facility and why?
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3. Think of a Port Angeles park you visit. What would you do, or like to have done,to improve your
experience?What do you love about this park?
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