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Agenda Packet 04/13/2012April 13, 2012 Applicant Interviews Utility Advisory Committee Applicant Interviewed: Catherine Harper Daniel Hudgings Donald Perry Robert Reed Andrew Schwab Murven Sears, II o Betsy Wharton UAC member: Sissy Bruch Dan DiGuilio Paul Elliott Cherie Kidd Dean Reed A. Please summarize your background, work experience and education as it Score relates to utilities: 0 (low) 50 (high) Notes: 50% Weighting A Score Score B. What is your understanding of the purpose of the Utility Advisory Committee? 0 (low) 25 (high) Notes: 25% Weighting C. Why are you interested in serving on the Utility Advisory Committee? Notes: B Score 25% Weighting C Score Total Score (A -C) 1 Score 0 (low) 25 (high) 1 pORTANGELES WASHINGTON, U.S.A. APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: Ulf/ ,iJt/r a m; it ee C G i .x%n rte. Applicant Name and General Information 6. /4 First MI Last 02 W. Home Street Address P0/ /41'L e- ,s WA- 8 5 City v State Zip S'O 5oq ,o Home phone Work phone Cell phone wa-ife ce'-10 t 4?.. CO ti4 E -mail address Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Are you a citizen of the United States? Are you a City resident? If so, how long eoe-6 (0 inn0 17 5 Do you own/manage a business in the City? Do you hold any professional licenses, registrations or certificates in any field? If so, please list: t) L- 66)/'1 J 'Pr y "beac:`9% 1 Yes Yes e rrerienHa RECEIV MAR 1 4 RECD City of port ei es No No Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: (1 D Work Experience List most recent experience first, or attach a resume r.��vtl° u o Sorion'i V ?iri 6U5 Employer U Title Ot•f' iZzA -I P05 oil man 44 LJ MV`hi 1 pjSI" Title VP-.11'00 Brief job description Norc: i Employer Education List most recent experience first j51 0 i1 OM a 0 Ve r 5/ 'r�'c3l,Al %rt(' Institution/Location Degra4earned/Major areakf study 1 1 91 0h? Ji E" plats -c, 13 t o' f F1h Institution/Location D g ee earned/Major area of stud Institution/Location Degree earned/Major area of study Organization/Location Brief description of your participation: 44 !me/ wet r Group's purpose/objective PETA (/V r c7 N7'117i'" 2 If C•Urre /t14 c. Y"e) ?OC co From (M/Y) To (M/Y) �1 i ce' /9,8j- From (M/Y) To (M/Y) C 1 -e.`1 cal thief job description 1 Pdr• k School x! /3. Employer Title t 11 c/,25 h 1 d 5c'nv ie e- is hoo P he,- Brief job description /91a— /9 From (M/Y) To (M/Y) Yes No Graduated? No ray uated? Yes No Graduated? Charitable, Social and Civic Activities and Memberships List major activities you have participated in during the last five years /7'7 r11/.0/1-5 of members f ei.70 /`77//74 a ty/V7 Brief description of your participation: I j o��ICt c' i cfF' t"c�SC) c)r�r im4?Js 7 r 5 tK7Lr'/ I'Zta./ f! C -11 lam /t'. rAc' "h`t/'r ft/. Organization/Location Group's purpose /objects% of members Questions Why are you interested in serving on this particular Board or Commissio f rlc l v I?d -4 '1741,0 6 'Ies -CeS, 2,id a 4/-67i r e_s C a.5 6 r»r 1% ?r rF2d %n i1', f fivveshil -e. Cdr' v //,1,, 7.1r 1) What in your background or experience do you think would help you in serving on this Board? A d d- cZ 1 f )G11 -t /h a- r. /'7- li�S'. What is your understanding of the responsibilities of this particular Board or Commission? f ,S c1 G-,. *i 00. 119.e Ii eve tr4, ry 18 to oo d L'Y7 x:17 l 1 e I i s 1-en7, W re In D` fi We v/d f dtara, -z;), "-rely e 'woo ire Pro VI' tIe if, 12d- 54.- 0/1 MI-1 /-6701. e I f d,fi h e&a5, v Please feel free to add any additional comments you wish to make regarding your application. h 7a' 'Hie re will 1 d C 7 i oe.,7 !?',7i S si i(.. 14 .4.1.1 is Co Ap' licant Signature Submit completed forms to: OFFICE OF THE CITY MANAGER City of Port Angeles 321 E. 5 Street PO Box 1150 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 417.4500 so appropriate arrangements can be made. 3 jj/v//-2- Date PORTANGELES WASHINGTON, U.S.A. APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: Applicant Name and General Information First MI 10( Home Street Address Pmt ar City NGO) L iC7 35'7 Home phone Work phone E -mail address Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Are you a citizen of the United States? Are you a City resident? Lf],..a4 7 4 eg 36,""3 State Zip If so, how lone N 0 Do you own/manage a business in the City? of -or n 4 .�ry f «4nQ er ri. Do you hold any professional licenses, registrations or certificates in any field? If so, please list: 41,71 4/6''y Last (.1 0 Cell phone Yes No No RE CEIVED MAR 6 RE'C'D City of Port es �11 Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: J 1SO Work Experience List most recent experience fi Employer Brief job description Employer Brief job description Employer Brief job description Brief description of your participation: Organization/Location Brief description of your participation: Title Title Title or attach a resume Education List most recent experience first 4' 2 `E 2 From (M /Y) To (M/Y) From (M/Y) To (M/Y) From (M/Y) To (M /Y) Yes No Institution /Location Degree eamed/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 -0 ,,y7, o-r. pc.ZW 1 0 The c'n c (viii u-7 k.) 4`-r- Organization /Location Group's purpose /objective of members Group's purpose /objective of members Questions Why are you interested in serving on this particular Board or Commission? -4 1)-P kpe. certv✓vo_ rrOtOt P -?are spy ,r v 4 i'1r.4 c. i.ga rntiatit ,r/ OMI ce, ize. art, u T7 lr ∎YLe4.441 R-rieA rWJ yb n ar2.�.� /Lt oral n c4.7"-ell C9I a e y+1 C /r4-44- ceo. (M.o c.a 0. What in your background or experience do you think would help you in serving on this Board? 41- cfrry% 49....-",u 67 o A.,A.. r j 2 ,,go -r, Q l�'�'WHVTf« L�Lt1.O L GIN &iR/1'� /[./VK?.. IredLeA(GUL CJ7. /77-)-61 v r7.[1 a. 1 .,c ,f,4tlrl.`� .a 6 Q What is your understanding of the responsibilities of this particular Board or Commission? 7 rr,ot ..P144 f A 11.1. ,01-e4 vt -tea JG irv. r IV c ().ar2 L.6 414 4,c4 Please feel free to add any additional comments you wish to make regarding your application. 03/r� o<a Applicant Signature U Date Submit completed forms to: OFFICE OF TFIE CITY MANAGER City of Port Angeles 321 E. 5 Street PO Box 1150 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 417.4500 so appropriate arrangements can be made. 3 Daniel W. Hudgings, MD Family Practice and Geriatrics Home: 2101 West 4 Street Port Angeles, WA 98363 (360)457 -8857 Education: 1983 -86 Wyoming Family Practice Residency Program 1983 MD University of Miami 1979 Ph.D. University of Maryland (physics) Licensure: Washington Certification: Diploma, American Board of Family Practice Certificate of Added Qualifications in Geriatrics Employment: 07/95 to 08/11 Staff physician, Primary Care Clinic, Port Angeles (initially was Virginia Mason clinic, now OMC). Medical Director, CCC, 6 years 09/89 to 05/95 Sage Memorial Hospital, Navajo Health Foundation. Staff physician at a small, remote hospital. Outpatient, inpatient, obstetric, emergency department, and preception duties. Medical Director, Toyei Nursing Home. 05/87 to 07/91 Mammoth Family Clinic, Yellowstone National Park. USPHS physician in an isolated clinic serving residents of the park and nearby communities. 07/86 to 09/86 lnstaCare of Casper, Casper, Wyoming. Urgent care clinic. 07/86 to 09/86 Part-time instructor, Wyoming Family Practice Residency Program. 07/83 to 06/86 Resident Wyoming Family Practice Residency Program. Previously: Employed as army officer, and as applied physicist at the University of Maryland and the Los Alamos National Laboratory. Honors: Chief resident (elected by fellow residents, 1985 -86) Parke -Davis Teacher Development Award (1986 -87) Professional organizations: American Physical Society References or publications are available on request. 03/2012 Home Street Address '7QItTANGfiLES WASHINGTON, U.S.A. APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: U4 C C GP.a v r r `f C' Applicant Name and General Information First or./ 1) '735 r /-4 MI ReCeiv MAR 0 SREC'D City of Port Dles Angeles a rz- r AA 4;z 6.i;. IAA c .36 3 City State Zip 74;)14s d time phone 'Work phone Cell phony 4 E -mail addresrs i 3 -2/ 5 Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Yes Are you a citizen of the United States? Yes No Are you a City resident ?eD No If so, how lone a 7 t Do you own /manage a business in the City? „as. No Do you hold any professional licenses, registrations or certificates in any field? (es No If so, please list: J J4 s J d -max.._ L,1 C56 1 Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: Ajt7 Work Experience List most recent experience first, or attach a resume i 78kve s C). kAki ft"? ,..5` 20o 1 .s.�,./s' Employer Title From (M/Y) To (M/Y) Brief job descriptipp rr 4 Employer Title From (M/Y) To (M/Y) 4 6: er +v i Brief job description Employer Brief job description Brief description of your participation: Title Education List most recent experience first �SNc r ral CC= P7 9 ////frC//Miv1L.S es) No Institution /Location Degree earned/Major area of study ''t irail'uated? A /r?JiLi eAffi ,a 2— C•�/2i� U ski Yes No Graduated? Institution /Location Degree earned/Major area of study 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 Group's purpose /objective of members Brief description of your participation: '4c S !",`.7 i .��1 y t97L/ S '7644 7:::;(2) ,-9Jt 75 0 6 /1 rs S j- fac3014.45 ry .-t Organization/Location Group's purpose/objective i 2 From (M/Y) To (M/Y) r of members 1 /!e_ 2 ��r✓� Questions Why are you interested in serving on this particular Board or Commission? 1 •rye 1/ 729 ei rzi -t 6 c. w (i 2. �a'• t, 4" e S i GL t //r e/ �c ."X L a 7-g 76 What in our background or experience do you thick would help you in serving on this Board? 4- 6 /8..+a 7 wet) vC )"Y -L9C1 L 1}4 What is your understanding of the responsibilities of this particular Board or Commission? 7� ./.0 e ter. Tie t`, r C •7i 1 r�zo& -C_ i Please feel free to add any additional comments you wish to make regarding your application. J n. 1 --4.atcge- E[ l +02,. 2 C. A( 7l a+ _.1._ eve- C: z) t--- vs-9e, .1'--- �l a r_ A° c''r S �r� r�itJ Y�....,�.� 5" 7- 7"r) t� 3-as• -�r� i �yE ..pplicantSi natufe ''fir r Submit completed forms to: „#7) OFFICE OF TIDE CITY MANAGER City of Port Angeles 321 E. 5"' Street PO Box 1150 Port Angeles, WA 98362 3 Date 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 417.4500 so appropriate arrangements can be made. APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: 5 0 1) sort i CD rYi 1■ a )QRTANGALES WASHINGTON, U.S.A. Applicant Name and General Information First �J� f MI 0S r) t 1 k)Art91 -U (ZGt1E Home Street Address Plirrr A 4 s W� 0( 6 3 City State Zip Home phone p l L Work phone Cell phone A 0-.0 G i r iS i 0 !/l 1 rflev c Clot Umai ess Last Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Are you a citizen of the United States? Are you a City resident? pp If so, how long t S T Zak Do you own/manage a business in the City? Do you hold any professional licenses, registrations or certificates in any field? If so, please list: 1 Yes Yes Yes MAR 1 RERV City of Port Angeles Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: Work Experience List most recent experience first, or attach a resume Employer Brief job description Employer Brief j ob description Employer Brief job description Education List most recent experience fast Institution/Location Organization/Location Brief description of your participation: Title Title Title Si b 4 04,1% MS C1 uit Institution/Location Degree earned/Majorrare of t y area to la I Of.9 C lq-ev lot f�° tip 1 C (t iCf:-.Sc-'S institution/Location u n ,f-0 ii i 5j ,.Degree earned/M4jor area of study Degree earned/Major area of study 2 3 f AAG -ttf1 From (M/Y) To (M/Y) From (M/Y) To (M/Y) From (M/Y) To (M/Y) 6 uated? (,Yes No Graduated? Yea No Graduated? Charitable, Social and Civic Activities and Memberships List major activities you have participated in during the last five years 1%,,t(-9A 1'114.1{✓ iiti�5 (-f 45 r w 2 Organization/Locatioh Group's purpose/ objective 1 of members Brief description of your participation: 't3 CA 5 C; tzar cr tx.�fL. Group's purpose /objective of members Questions Why are you interested in serving on this particular Board or Commission? k9Awx (2.411.A.) ,St lA it U� M g 0T �il¢h 19$P Ire iM.i✓ e Lia- Aa C6 1�t111 U u What in your background or experience do you think would help you in serving on this Board? 1,w 114S, ti t) e cam t2c ta-c f �.n 11J1£(1A ilt -O h? t c� X r Submit completed forms to: 1 1 /i.I it OFFICE OF THE CITY MANAGER City of Port Angeles 321 E. 5 Street PO Box 1150 Port Angeles, WA 98362 3 What is your understanding of the responsibilities offthis particular Board or Commission? [G t7� _1aJ n Y C4mu Cfrw.fM i Ili°_ e 5�PS a-S m r,,,IA �.L; u eariv tnr- h,(�,. V'-- 41 e- l t )'kri. X Cf ,v—A M (M Olt r a (.e (lair Please feel free to add any additional comments you wish to make regarding your application. Date In compliance with the Americans with Disabilities Act, if you need special accommodations because of aphysical limitation, please contact the City Manager's Office at 417.4500 so appropriate arrangements can be made. Robert Reed 3/1.5/2012 Position Sought: Community Representative Port Angeles Utility Advisory Committee Summary of relevant qualifications: Technical Skills: Other Experience: Robert J Reed 605 Milwaukee Drive Port Angeles, WA 98363 a pproPoPo6881ahotmail.com (360) 504 2423 Previous Volunteer needs assessment facilitator for Clallam County United Way Project `Voices' Individual and Group facilitator for Diabetes Complications and Control Trial Group facilitator for UCSD SOM Department of Endocrinology program in medically supervised weight reduction for morbidly obese persons Counselor UCSD project in Polysubstance Abuse Psychiatric Technician UCSD Medical School Department of Psychiatry acute inpatient care unit Master of Science degree in Clinical Psychology, San Diego State University Software Microsoft Word, Excel, Powerpoint Statistical Software SAS, SPSS, SPSSx Graphical Software Photoshop, Sketchup, Microsoft Paint. 35 years in medical research variously responsible for: Project and Laboratory Management Data management, collection and analysis Grant proposal writing Manuscript writing for peer reviewed publication >45 articles, book chapters, posters, scientific and clinical presentations) Staffing and supervision Robert Reed 3/ Prior Work Venues (recent to distant): O Department of Defense Center for Deployment Health Research Naval Health Research Center San Diego CA o University of California School of Medicine Departments of Psychiatry, Endocrinology, Pulmonary Medicine and Neurosurgery o Veterans Affairs Medical Center, La Jolla CA Research, Psychiatry and Psychology Services References available on request jC1RTANGfiLHS W A S H I N G T O N U.S.A. APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: S )4;11y Adv;$o i C fe e Applicant Name and General Information 1 Andrew b ,sc. h the First MI Last 111 F le Home Street Address Pot4 A emeta 61 it 18.3C0 City State Zip lVa, 3 (.0- 7/7-1313 T37- 194 -/42 Home phone Work phone Cell phone onime tlrno:1.cam E -mail address Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Are you a citizen of the United States? Are you a City resident? If so, how long Nov AS- 00 3 t o IS Do you own /manage a business in the City? Do you hold any professional licenses, registrations or certificates in any field? If so, please list: 1 R e CEIVE MAR 16 REC'D City of P ort A /0 ',2$' Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: a 4 4ha Aware O� Work Experience List most recent experience first, or attach a resume Please See u 44acmePI 4 Employer Title From (M/Y) To (M/Y) Brief job description Employer Title From (M/Y) To (M/Y) Briefjob description Employer Title From (M/Y) To (M/Y) Briefjob description Education List most recent experience first Please cop 4.I -4ac •1 Yes No Institution/Location Degree earned /Major area of study Graduated? Yes No Institution /Location Degree earned/Major area of study Graduated? Yes No Institution/Location Degree eamed/Major area of study Graduated? Charitable, Social and Civic Activities and Memberships List major activities you have participated in during the last five years J j r 1 A no eltc �Qai iViett �SSOGQT16Yt develvPand Prenvlt a Areitl►.rcf'wn "A OD 4 Organization/Location Group's purpose/objective of members Brief description of your participation: kwc ael-fd uc u boar(' rnelne, acne) haw SID beta 4t PMrne1 S i s 6-1 ka I DetSovt Si n re aO /O 2 La in goy Sc ifoul) j(qa Build elldrac J Civic CAtecirbetS ane14nets l l Organization/Location Group's pu'rpose/objective of members Brief description of your participation, "L haw. be.n 14 a s 'fe/ 4.140 acIu 1 (.e Jot) 1:4er Questions Why are you interested in serving on this particular Board or Commission? a.,,m a1, ray i n1ere�4a Sarv 1%e C; 10 4 r he ab; l :kes. As A vvv,t, -42119"---e LAI bosyne miner 1 o ffer w ..f.rifftri p ozn 4_ n� 7 f 1 A.4. u IV 4_ u v j 0.1414 4o llavC OW Iii id( pow 4 s n v sent( II'' enta);4: es ff ueLi a.' r. 4- 2vetvnw, i n 41.4 017. What in your background or experience do you think would help you in serving on this fy I f ',I bac ica�ro�,n for tom; fife O ba;n� an Eue w+a�n.. AS a [o�mrnvn, y /'s oltirn��;ve 1 rr 1 r f 1 7 tee '4 �L nnMOr4�4 4n bay/ malty tt e%eA4 p e n'FS oT o' aryl 1 6 4 9 _I am o, dirge odvca4fo y y b neit bwter. What is your understanding of the responsibilities of this particular Board or Commission? The UAL. meek once u wl0V lkJn a 4 v'SOry recomr► 4v the e;17 Gvvnc remark y ut;j;� r'ot►c 0 plfw 47uc. Please feel free to add any additional comments you wish to make regarding your application. c alti' yS ;n J iet SttvMIA Ctil.. '[•F T LOA t 4 el ciel 'Fee +kr UAL 7 Z wow td 1)k th kno'.r o4 Other wut. Lav, S'MAC_ j 3/15/1 Applicant Signature Date Submit completed forms to: OFFICE OF THE CITY MANAGER City of Port Angeles 321 E. 5 Street PO Box 1150 Port Angeles, WA 98362 3 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 417.4500 so appropriate arrangements can be made. 1/10- Present 2/04 -3/10 11/02 -11/03 Andrew Schwab 116 E 10 Street Port Angeles, WA 98362 (937) 694-1427 Education: 6/2009 Bachelor of Applied Science, Applied Management Peninsula College Port Angeles, WA 6/2007 Associate of Applied Science, Business Administration, Marketing Option Peninsula College Port Angeles, WA 6/2005 Associate of Arts, General Peninsula College Port Angeles, WA Employment: 4/10- Present Port Angeles Downtown Association Port Angeles, WA Board Member Appointed in 10 /10 to finish year term. Elected to fulfill 2011 -2014 term. The board represents over 200 Port Angeles Downtown Businesses. The purpose is to develop and promote a healthy and prosperous Downtown for Port Angeles. As a board member, I oversee five committees devoted to the revitalization of the downtown area. Promotions Committee Chairperson Joined the Promotions Committee in 4/10. Assumed the role of Chairperson in 10/10. The goal of the committee is to create a positive image to increase community pride and improve consumer and investor confidence in the downtown area. 1 oversee advertising, retail promotions, special events, and marketing campaigns to help sell the image of downtown Port Angeles the community and surrounding region. Anime Kat LLC, Port Angeles, WA Owner Full profit and loss control. Works with several distributors to achieve an effective product mix. Every operational month is above break -even because of a successful marking mix. Controls all day -to -day operations. Wendy's of Port Angeles, Port Angeles, WA Assistant Manager Responsibilities in addition to past responsibilities include: the hiring and retaining of Crew Members, conducting disciplinary actions against Crew Members who violate rules, inventory orders, and assisting the General Manager in planning store goals. Shift Supervisor Responsible for hourly and end -of -day operations. Includes: inventory, cash control, nightly closing procedures, continuing training of Crew Members, customer complaints, controlling labor, and other managerial duties. Promoted to Assistant Manager on 7/07 Crew Trainer Responsible for the training of new Crew Members and the continuing training of existing Crew Members. Training focuses include: customer interaction, safe food handling, and quality assurance procedures. Promoted to Shift Supervisor on 5/06 Crew Member Responsible for the preparation and cooking of food, the taking of orders and payment, the expediting of orders, and nightly closing procedures. Promoted to Crew Trainer on 11/04 Awarded Employee of the Month for November, 2004 Awarded Employee of the Month for May, 2004 McDonald's of Broad Street Fairborn, OH Crew Manager Training focuses include: customer interaction, safe food handling, and quality assurance procedures. Awarded Employee of the Month for September, 2003 First Home phone '7QRTANGBLES WASHINGTON, U.S.A. APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE Board, Commission or Committee to which you are seeking appointment: Li ft-.li ILLS A ViSo(L i C Applicant Name and General Information 3Cc ega -rkr miiry 5 6' u{h�i0D.623.44 E -mail address (f a MI Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Are you a citizen of the United States? Are you a City resident? If so, how lona If) .c L A f j,,S Do you own /manage a business in the City? Do you hold any professional licenses, registrations or certificates in any field? If so, please list: S E A Last (o03 MILL AL LE 2tiJ Home Street Address Porz -r A i s Etas Qt C City t State Zip Work phone Cell phone 1 REC EIVED MAR 16 RECD City of Port es q Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Yes Ye No es No Yes No' Yes No Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: Work Experience List most recent experience first, or attach a resume 6 00706 11 CDs f 6 1 s 1 titFwP/ reAti ro 8 710 Employer Title From M/Y) To (M/Y) VJk oC PcSr s r1•1 Pomer P, put.s, Et Etr c, oPi?c.( Lptrif J' Brief job description Employer Title From To 4-14 P44.,o cr 1 T M -rani 6 Brief job description ER-eu �r G t pol flc- Employer Title tiAlidtoas 1"" t li ics pS ct j enACt6 t Aj Brief 'ob description �A �i�c >Cz. 0•`o R F3/1- T L A) ILL L1tc)JC- UPe/Ly*riewl Education List most recent experience first L. Stie 1 pr- (J,cslc� c. ,tom f.`-{ Jat<.>Il L- C Yes No Institution/Location Degree earned/Major area of study I1ated? Yes Ng Degree earned/Major area of study Graduated? Yes No Degree eamed/Major area of study Graduated? Institution/Location Institution/Location Charitable, Social and Civic Activities and Memberships List major activities you have participated in during the last five years l3S asso Cw b oP tuf S ci ODD ~1 Organization/Location Group''s /objective of members Brief description of your participation: 1Z-t. tit- `Jt CAS P 114141 -Kn p 4.4111 c Tb P t P'' t d 9 5r.,361a 15F U ,S 1 T L El-Yu t C mere `�e 5etaMr( i 12ctCTi ONie- th031- p1/436 &4 tnJ Evu' ti 65kDt( C4.1 L(trt Pap'' Organization/Location Kdra t Group's purpose/objective Brief description of your participation: 0.01) i.J k f 44 tom/ 2 S Ttf"GLe- NA NA46. 1 tic From (M/Y) To (M/Y) ()l) 1 of members Questions Why are you interested in serving on this particular Board or Commission? ID Be (9 P S C"( s 1 cif 6AY -Ton Ltd-4_171e- Ad- LI S e err My t PCtz lt:: oCc7 t e Mt tF11 TALE/3-7 LT kg Titiitcam r'ua— AMf ea, 11 0e. `Tb P »tT 61 t`_S &)W1g i r C to What in your background or experience expericfce do you think w uld help ou in serving on this Board? M 6e7flkSI 04S t�C S-s L 1! WPottr ,1 f" c_ ,001,0k Otoik L Y 6$1 4 .s jMC We JO 1 r V T 60411/44 ,»j 1 t 14 A d k What is your understanding of the responsibilities of this particular Board or Commission? rfZ� LASS! mi. AA. opt rc-1 L,r;r 7LS A.cJA.11is!1 i)i 7t)ee is °rtL! Ili Is u13.5 l�c� li4 c+ s: CCoNt 'c. "71D 44 ANCi�,t(z C E_Gt c' A--Ss 1— /4'3 en.-2) 4 s c.i e?' flabtA.a. Tizmi G, /t owl 01 tdt i 1 S Tb ALL &3S, \a A, s Please feel free to add any additional comments you wish to make regarding your application. 8021.40 S e T1t 11-s .4 1 S A-- �r6:24 7b /Z f r 2tr ,'+J AgO ti,t, A fforvi6r 1 L D (le 11-r. WA. no P ioLitrr __/`ik eS iA Li3 ifrhs 7 t b -4LE A r)12..(f 1 `i i--tc city 11 1 Applicant Signature Submit completed forms to: OFFICE OF THE CITY MANAGER City of Port Angeles 321 E. 5` Street PO Box 1150 Port Angeles, WA 98362 3 2 cu Da e 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 417.4500 so appropriate arrangements can be made. 3 RE CEIV P ORTANGELES MAR 1 6 RECD c2vc200, c City of Port Angeles t9 APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE WASHINGTON, U.S.A. Board, Commission or Committee to which you are seeking appointment: L 'fl l4 A Ad v) I n 0 Applicant Name and General Information t 5 /)bd W First MI) Last 3 2p 7 S Atalde Sk-g--(4 Home Street Address �vy)• 8 31�� City State Zip Ol 0 kR o e Hoare -phone k- r Work-phone phone W qr ii (Za(Lk c ►'yl E -mail address tai Date of Birth (to be completed only by applicants for Public Safety Advisory Board for purposes of criminal history check to ensure compliance with Port Angeles Municipal Code 2.26.020) Certification and Location Information (circle one) Are you employed by the City of Port Angeles? Are you a citizen of the United States? Are you a City resident? l kt-LStAe2-5 Do you o a ge a bu ines in the Citylot 11c1r4 yi In �.•O Do you hold any profession license, registrations or certificates in7fy field? If so, please list: .F If so, how long 1 (Cell phone) Yes Ye No 'es, No Yes/ No No Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so, please explain: r+v Work Experience List most recent experience first, or attach a resume A irs %Dip o ��a� Ca Q,L, 12K.) t° zoo-L. Title From To (M/Y) Employer J 1 i /I., Brief jo. descr to Re,4 Employer Brief job d a Brief job description Institution/Location Institution/Location tion A/04 1\ CO LPAA0A4A67 1 1Wpto /2- 41 Title `From (M /Y) To (M/Y) Education List most recent experience first uhl 1 Institutio t cation 1abtot9,4A...w0c41 EAA Organization/Location J C��a'vLS2�1/J //40 From (M/Y) To i z_ )(&1.1 n v 'Title 1 2.01 0 Degree earned/Major area of study I 811 Mc� Degree earned/Major area of stud 4 Degree earned/Major area of study Charitable, Social and Civic Activities and Memberships List major activities you have participated in during the last five years t ma, A 1 Organization/Location f Group's purpose /objective of members Brief description of your participation: YJ 2 U YSI4 (Ye o 'iadttgted? Yes o meted? Yes_No Graduated? sr.) 200 G., ✓vim►.. V Group's purpose /objective of members Brief description f your participation: cx 9�n SM CD 2nto 7 Questions Why are you interested in serving on this particular Board or Commission? 1 kui c (nfi s a „L„....01t ..„4.__LLAA.ct 9 What in your background or experience do you think would help you in serving on this Board? SQ4e 4 0 n IY9 -Y�n 1 /ZA0(4 12/2_00 9 G yr\QAAA1 at C c� l/ What is your understanding of the responsibilities of this particular Board or Commission? f,p_h t 0.A IS S,,a..4 40 a c.;-19 Please feel free to add any additional comments you wish to snake regarding your application. Applicant ature Submit completed forms to: OFFICE OF THE CITY MANAGER City of Port Angeles 321 E. 5 Street PO Box 1150 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 417.4500 so appropriate arrangements can be made. 3 Z Date