HomeMy WebLinkAboutApplication J Thornburg The City of Fort Angeles
'Advisory Board Application
Parks, Recreation and Beautification Commission
Applicant Name and General Information
Position applying for (check one): R Commissioner Student Position
Jacob H Thornburg
First
MI Last
2424 S Cherry St Port Angeles WA 98362
Address City State zip
360-461-3030 360-461-3030
Home phone Work phone Cell phone
jacob.thornburg@gmail.com
E-mail address
Certification and Location Information
Areyou employed by the City of Port Angeles?......................................................................................................................................................................... es
Areyou a citizen of the United States?...................................................................................................................................................................................................
Are you a Registered Voter?.......................... s o
Areyou a City resident?.......................................................................................................................................................................................................................................... o
Ifso,how long:........................................................................................................................................................................
Doyou own/manage a business in the City?................................................................................................................................................................................... es
Do you hold any professional licenses,registrations or certificates in any field?.................................................................................. ® ®°
If so,please list: CDL, Pesticide Spray license, Flagger certification, CPR/First Aid
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:
No
—youawaituiauy uumuctofinterestwmcn might ansebyyour service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
—youawaituiauy uumuctofinterestwmcn might ansebyyour service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No
�.�you await ui auy uumuct of interest wmcn might anse by your service on the advisory board that you are applying for?
If so,please explain:
No