HomeMy WebLinkAboutApplication K McGuire _IVED
The City of Port Angeles Al R, - 2 02
,., Advisory Beard Application IT D
C-I IRK
Parks, Recreation and Beautification Commission
Applicant Name and General Information.
Position applying for (check one): Commissioncr 0 Student Po ition
first MI Last
Address City State Zip
Dome phone Work phone Fell phone
lit,1 t
E-mail addr
Certification and Location Information
Are you employed by the City of port Angeles?, ,..,.,.. ..... ......... ... es
Are you a citizen of the United States?...... .................._... ,.,....._ ..... ....,,, ............ ......... o;
Are,you a Registered Voter`m,....,_.. .....,... o
Areyou a City resident"?. .. ............ ........... ...................... ......... ....,.... .......... ................... o
Ifso,how long:...._.................. .. _...................... .......... ..,... _._..._ ......... .......... .........
Do you own/manage a business in the City?.......w................._. ,.....,.. ............. ....____. ,,,.,.,,, _...___........_...... __._.
Leo you hold any professional licenses,registrations or certificates in any field? __ ....,, _...... e
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 ford'
If so,please explain:
Areyou awareor any contnet or interest Nvnicri might arisetryyour service ontheadvisory wardthatyou are applyingtor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on the advisory award that you are applying tor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on the advisory award that you are applying tor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on tile advisory aboard that you are applying tor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on tile advisory aboard that you are applying tor'!
If so,please explain:
NO
Areyou awareor any contnet or interest Nvnicri might arisetryyour service ontheadvisory wardthatyou are applyingtor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on the advisory award that you are applying tor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on the advisory award that you are applying tor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on tile advisory aboard that you are applying tor'!
If so,please explain:
NO
Are you aware or any connect or interest Nvnicti might arise try your service on tile advisory aboard that you are applying tor'!
If so,please explain:
NO