HomeMy WebLinkAboutWojnowski Application 01/30/2017 QR
TANGELES
I' WASHINGTON, U. S..
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APPLICATION FOR APPOINTMENT To B.w ARD1 ,COMMISSION OR COMMITTEE
Board,Commission or Committee to which you are seeking appointment:
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Applicant Name and general Information
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First MI Ease
Ti e Street Address
City Ul state Zip
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Horne phone .. Work, one Cell phone
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-snail address
Cate of Birth (to be completed only by applicants for Public Safety Advisory and for purposes of criminal
history check to ensure compliance with ford Angeles Municipal Code 2.26.020)
Certification and Location Information(circle one)
Are you employed by the City of bort Angeles? Yes So")a
Are you a citizen of the United States? es No
Are you a RegisteredVoter? es No
Are you a City residents es No
If so,how long.,___www '- S'
Ngo you ownhrwana)e a business in the City? No
Do you bold any professional licenses,registrations or certificates in any field„ efe-s No
If so,please list.:_fl,
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Are you aware of any conflict of interest which might arise by your service on a City Board or Commission? If so,plea
explain_
Work or Professional nal Experience-List most recent experience first,or attach a,esuLeEm yc,reFrom( ,fY) 'ILo1�"��
Brief job description
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Ehiployer Title From(NVY) To(M/Y)
Chief job description6
Employer Title From(Lwt/'`a')_ W To(NVY)
Briefjobde, iption qf0l�\ 04ut"'h
Education- List most recent experience first
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Institution/Location Lyegre rneddlvl'' a of study JJ 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 Live years
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Organization/Location Group's purposelobjectiVe #of members
Briel descri tion of your participation:
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Organization/Location Group's purpose/objective #of members
Brief description of your participation:
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Questions
Why are you interested in serving on this particular Board or Com,i sio
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g k would help you in rwin can dais Bo ?
atm aar background or ex raene o ou thin
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What is your understanding of the responsibilities of this p, ticu ar Boardrr
Commission?
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Please feel free to add any additional comments you wish to make regarding your application.
App icant Signature Tate
Submit completed farms to: OFFICE OF THE CITY CLERK
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Jennifer Venelclasen,CITY CLERK
360-417-4634 or iveneklaAcityof a,us
City of Port Angeles
321 E. 51"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.
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