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HomeMy WebLinkAboutApplication JacobsenThe City of Port Angeles Advisory Board Application Parks, Recreation and Beautification Commission Applicant Name and General Information RECEIVED NOV 12 2020 CITY OF PORT ANGELES CITY CLERK "e. _ 4 -�Txc&6S e �l First MI Last [jZo 4e� �' ._ Pc) c� A &CLNG WA Address City State zip C-MoJg9 a -3 `t NIA (3 6©) 6 qo - 453) Home phone Work phone Cell phone E-mail address Certification and Location Information Are you employed by the City of Fort Angeles?_.:._:.:.._.._ ....... ..... ..___ .... __:... :. __.._ ____..__------- Yes iVn Are you a citizen of the United States?._._..._..__...._.._._._.._.._._.._.._...._.._._..____...._..._.._......____.._.. r Yes No Areyou a Registered Voter?____ . .. . ..... . . . ............ ..... ____ ...._...... ........._... __................. _ .� _. _.. _.......... Yes Na Are you a City resident?— �___ _ _ _ _ __._._._._.__.._.._..�...._..�___. _._ _. Y _ .__ ......._.---__. es No If so, how long: Do you own/manage a business in the City?__.--_ �_ __ _ A Yes No Do you hold any professional licenses, registrations or certificates in any field?._.._.__ _ Yes No If so, please list: 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: A 2 8 2018 DD 0i i vFi i F ■� The City of Port Angeles Advisory Board Application ti Work or Professional Experience - List most recent experience first, or attach a resume Employer Brief job Employer tj Brief job descrip Employer Brief job description Education — List most recent experience first L Yes No wv�fe��..�� lnshtuhanlLaca on Degree earned/Major area of Study Graduated? Yes No 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 Organization/Location ,e LL Brief de ripb n of your participation Organization/Location Brief description of your participation � -J&rtL --TE-k purpose/objective Group's purpose/objective ►•,��� The City of Port Angeles Advisory Board Application Parks, Recreation and Beatification Commission Applicant Supplemental Questionnaire 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? L �arillg-- �r>y0�� of c,P nJr 2. What is your favorite City of Port Angeles parks and recreation facility and why? t 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? Mal Applicant Signature Date g a,-�jg Submit completed forms to: Office of the City Clerk City of Port Angeles 321 East 5'° Street Port Angeles, WA 98362 Jennifer Veneklasen 360-417- 4634 jvenekla@cityofpa.us 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.