HomeMy WebLinkAboutMilliren Application 02/14/2018 (2) The City of Fort Angeles
Application for Appointment to Board Commission or Committee
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14 2018 (�
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Board,Commission or Committee to which you are seeking
Applicant Name and General Information
first 3 MI Last
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C,wty "state Lip
f lanae phone Work phone Cell phone
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E-mail dress
Certification and Location Information (circle one)
Are you cttap@aryed by the City ot'l"arrt Angeles?. ....... . .. .. ..... ........... .......,. ,,, , .. .......,. ..,,. ......._..,. ,,..., . ...
Are you a citizen apt°the United States'?. ......... ._.. .., cye7s � No
Are you a Registered Voter'?.,.,,,. ........... ._ ......,.. .. ,..�,.. _... ... _...�...., .,.. .. ,) G<a
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Are you a City resident?—....... ............. .............. ......... ....... .... ..... ...... Yap ) No
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Do you own/manage
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a haasaness in the City'?P........ .......... ,,,,, .,, ... ,,,...,, �........ ,,,....... ...........Yes Mica
y y p gi erfif�cates in any field?.. _.... .. ..... . .. .....................Yes CNo')
t)aa tato he�laf an professional 9ta.a�nses,re astr�atitans rar c'� ° u�
If So,picase ......... __._...........
Are you aware ofany contlict of interest which might arise by your service on the advisory board that YOU are applying f"car?
If'so,please explain:
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Work o P ...r Professional Experience - List most recent experience fiq'arst, or attach a resume
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Employer
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Brief odescription
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Employer
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Elrrel'"crh de
D scription �
Briefjob description t '
Education —List most recent experience first ;. .
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Institution/Location Degree earned/Major area orf`. udy Graduated?
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Instituti /1.. cation Degree earned Major area of,toy 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
last five years
during the la
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Organization(l ocatiotrCircru,'s to -/objective
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Brie'de riptionol'yourpailicipat'oa: t
Organ uratio> I_ocatio� � ' � p �o J tine
�"' �- Group's ur crse/oIr'cc�
Brief description of'your participatic n:
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A licants Signature plate
Submit completed forms to: Office of the City Cleric. Jennifer Veneklasen
City of Port Angeles 360417-4634
321 East 5`1 Street jvenelcla�cityofpa.us
Port Angeles, WA 98363
In compliance with the Americans with Disabilities Act. ifyou need special accommodations because ofa physical limitation,
please contact the City Manager's Office at 360-4174500 so appropriate arrangements can be made.
This document and all attached information is considered a public record and may be distributed to members of the City Council
for appointment consideration, ,=additionally,it may become a part of a City Council packet.
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Questions for UAC Candidates
1. Tell us about yourself - why is it a good idea for us to have you sit on the Utility Advisory
Committee? What useful experience, knowledge, or perspective do you bring?
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2. ln addition to monthly Tuesday aftemoon meetings, the UAC sometimes has site visits or joint
evening meetings with the City Council. The overall commitment for meetings and preparation, etc.
can sometimes be substantive. Do you have the time and flexibility to make this commitment?
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