HomeMy WebLinkAboutApplication Ramsey 01/21/2014 ......... 1
im ((I
2 ,.,� t
09 1A1 V GE L E
19 WASHINGTON, U1 S. A.
I,J.Ct.
APPLICATION FOR APPOINTMENT TO BOARD, COMMISSION OR COMMITTEE
Board,Commission or Committee to which you are seeking appointment:
55"lov
Applicant Name and (general Information
s&
First MI Last
1�2� 416s7- 137w Sma�r
Home Street Address
City State Zip
Home phone Work phone Cell phone
E-mail address
Date of Sh th (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 Na
Are you a citizen of the United States? Yes No
Are you a Registered Voter? Yes No
Are you a City resident? Yes No
If so,how long 10 qeAws
Do you own/manage a business in the City? Yes No
Do you hold any professional licenses,registrations or certificates in any field? es No
If so,please list: U"yd Kwfi 1 1T§16v
Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so,please
explain: s a.aoN ee- en 404
Work or Professional Experience-List most recent experience first,or attach a resume
--T
I it
Employer Title Fronf(M/Y) it(M/Y)
A�PmtvileAya�6r I
Brief job description
114-i`-A41 t$&`- 4604VI, Z413
EmploXr Title From(M/Y) To(MN)
)qq^4k4—
Brief job de ription
Employer Title From(MPY) To(M/Y)
Brief job description
Education - List most recent experience first
lfl+ e
Institution/Location Degree earned/Major area of study — rai'u'at—ed?
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 Group's purpose/objective #of members
Brief description of your participation:_
Organ ization/Location Group's purpose/objective #of members
Brief description of your participation:
2
--- -----------------------
Questions
Why are you interested in serving on this particular Board or Commission?
j e tlaW (AA*V C 4;4d_T14-e.. LA AME
&�t4 c4l Auks
aw- iVh Wf om+ -�* kw qm m a ke- 61 a "*,v-,elket CAW hippt
A"
What in yoti background or experience do you think would help you in serving on this�oa
0 ak-IM16,a di rdeflv' ► w/Vtj jV1 9-w-A 4 - 04-111
.......................
ct 6 +kpAs4- ado!iwmovwj,ti is 6wt4 ieAL awl-S co"~--01 -0+' !q&,,
What is y9ur understanding ofthe responsibilities of this particular Board or Commission?
-fT S
n�
-1,0�
CeWA I KAew( ws +P +At wamjs as<4 pAs�es qw.-d YL" of- +f%c
J
Please feel free to add any additional comments you wish to make regarding your application.
Applicant Signature 13 to
Submit completed forms to: OFFICE OF`I CITY CLERK
JANESSA HURD,CITY CLERK
360-417-4634 orjhurd@cityofpa.LIS
City of Port Angeles
321 E. 5"'Street
PO Box I ISO
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
................