HomeMy WebLinkAboutApplication R Gelder The City of Port Angeles
Advisory Board Application
Parks, Recreation and Beautification Commission
Applicant Name and General Information
Position applying for (check one): Commissioner Student Position
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First MI Last
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Address City State Zip
Home phone _ Work phone Cell phone
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E-mail address
Certification and Location Information
Are you employed by the City of Port Angeles?........_....-, . .. `.. .,. ........................ 'cs
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Are you a citizen of the United States?_,.,.,,,,, „..
Are you a Registered Voter?...... � -
Are you a City resident? ..... ... ... o
If so,how long.
Do you own/manage a business in the City?...... ................................................ 'es
Do you hold any professional licenses,registrations or certificates in any field?................................................................................. Fc
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If so,please list: Q t" d°
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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The City of Port Angeles
Advisory Board Application
Work or Professional Experience - List most recent experience first, or attach a resume
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Employer
Brief job description
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Employer
Brief job description
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Employer
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Education—List most recent experience first
Institution/Location Degree earned/Major area of Study Graduated?
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Institution/Locado'n Degree earned/Major area of Study Graduated?
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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
Organization/Location Group spurpose/objective
Brief description o /
f your participation
Organization/Locatioi, Group's purpose/objective
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Brief description of
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I'' � The City of Port Angeles
,i -" Advisory Board ARplication,
Parks, Recreation and Beatification Commission Applicant Supplemental Questionnaire
1. 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?
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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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Applicant;Signatu a Date
Submit completed forms to: Office of the City Clerk Kari Martinez-Bailey
City of Port Angeles 360-417-4634
321 East 51h Street kmbailey@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 360-417-4500 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.