HomeMy WebLinkAboutApplication Volker 04/02/2013 r
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APPLICATION LICrw4aTIO FOR Appo1N"l"MENT 'ro BOARD, COMMISSION OR COMMY11"TEE'
Board,Corwimission or .roar ttee to wbich you are seeking appointrrr trt:
Applicant Name and General Information
Fiat W Last:
Home Street AcWress
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City state �lr
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l-lnrTTnc Plncanc Work phonic Cell phone
F-maali aaalclress
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flame of ltirtlr (to be completed only,by uppincuurnts for Public safety Advisory Board for lrtrr° ows of er nnrrnal
history check l:ar ensure Compliance with Port Angeles Municipal("ode 2.26.020)
Certification yard Location Information gcirrcic one)
Are you employed by the City of Port Angeles? Yes C_111)
Are you<a citizcn:crfflhe llnitcal States? y" 11 No
re your an City ncs,klcnt;l '�a'1 No
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Do you mvrr manwjtc a1 business in the City? y es, No
DO ynnu 110W any professional Incense,,registnadons or ccntil-icaatcs in any fi tl? Yes No f T_,.�4
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Are You aware ol'ally col I ilio of'i n terem which 11lighl ansc by youl Service ol I as City Bonrd or 11'su,pl case
explain'. nD
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Work Experience- List most recem experience first,or attach as resume
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huployer J1 Fro,", I'o
Rricfjob description
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EnIployer TkIc From(N4/Y) 'To M(Y)
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Brief jl de
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Employer l'itic From(M/Y) To(NIN)
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1�u description
Education -Lim niost recent experience first
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wti o n/ oc a o t I DeN CM,lled,/M a I-ca of,Study radwMed?
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Degree cai ned/Major a ea Of'S(Udy /,;radualed?
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Degrec ea nickilmaj Or arca of'skudy
Charitable, Social and Civic Activities and Memberships- List rnajol-activities You hm e Participated ill
during than hast five years
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Brid'descripfion ol"yow,paiticipatioll:
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Olga nizatiorl/Yocafioll ORKIP'S f)Mj)0,I,�C/0b,jCalVC 1, 01 uncillbels
F160"descripli011 Ol'your ........,
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'+i lly arc You into
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What irr your background or experience do you think would help you, in serving on this Board?
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Pie-rsu feel free to rrcici any a ddi7ion,"l crwn,rrwaerrt"s you wish to rya"rake regarding your r,,ipplication,
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Applicant ronrtur . Date
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Submit completed forms tor: () Ftc E OF THE CITY A Ac:ER
360417-46310 or it iiet-cc(4`Icityt)id'laa.tis
City rwt"Port Angc1c:s
321 E. Sid' Stre t
6'0 Rox l 150
Port Angeles,WA 98362
In e^:orrrtapi�aaruca with the rwarredcarrrs vs uh t"7assrbihoes Act, i1'y a teal sp caul uc c;ramrrwodwirrrrw t c au,sc trt"d J)hywiCa1
lnarritatirarr,1rpCOSaa COW UL 011 City Manager's t fflice u[4 p 7.4500 so ar prop riaale arraangenrr nts c.arr be rwrarcicr.
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