HomeMy WebLinkAboutApplication Volker 08/06/2012 �x
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A S H i IN G T 0 N,„ U. S. � � V
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APPLICATION FOR APPOINTMENT To BOARD, COMMISSION OR COMMITTEE
,Board,Commission or Committee to which ch you aim- seeking,appointment:
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Applicant Name and General Information
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i" t M1 Last
i.irarrae Street Address
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Z"ity State Zip
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0icaraae phrarae ..�....�. Work phonedell phcarae .�.�. ...�.�_.�.�__.
E-mail address
,eta aa'ita to he completed only by applicants for Public Safety Ady6ory Board for purposes of criminal
history cheek to erasure compliance with Port Angeles Municipal Code . u . l
Certification anal Locution Information eir le orae)
Are you employed by the City of Port Angeles? Yes QNP)
Are you as citizen of the United States? No
Are you e City residenf? (Yes o
If so,how
_...._...._______.___--------
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Do you own/manage bwsiness in theCity? Yes e
Do you hold any professional licenses.„registrations or certificates in any field? "des
If so,„please last
Are you aware:of any on.flict of interest which might amiss by yourice on a City"Board,or Commission? If so,plMse
explain:
Work Experience- List most recent experience first,or attach a resume
Employer Title .frrrrrM( ) a 6 /' )
Briefjob description
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Employer .__w__. .�..�..�._f"cte_....... ..�..W. ...,: ..� .a. ..�Frrrr f l/Y
On"iefrrlrdescription
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s r� tion
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L rief gala description
Education- Dist most recent expe!rience first
Institution/Location Degree eanied/Major area of study Graduated`
Institution/Location Degree earn a rrr area of surd ra rrat d�
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fn 7%t /-,'1' ,.��_,� traradrrated
Charitable,Social and Civic Activitiesand Memberships-Dist mtkior activities year have participated in
daring the last five years
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Org z tier been Group's purpose)objective fi of miembers
Brief description of your participation:
L.5r are atfnraJL� C tin ._...w.........._..._.._ _ .__Creon 's l.ur `d j e c—ti v
phren of our Lrarticf aticrrr: w...
Lrref descry �._.._.___._....._,_..�_.,.�......_................�_,..._....__4___w.,....._...,...,,,�..,._._�_.�.�_.��....M...•__.___.. ...__�_,M.... ._._.......
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Questions
Why are you interested in serving on this particular Board ot Coinnussion9
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What in your background or experience do you think would help you in serving on this BoatV
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,,r,qAjtC 4 c,,,ewepoiz.- ifA49e pjUP1Ae,'
What is your understanding of the responsibilities of this particular Board orCommission?
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Pf�120 06-;- rC)AJ D 1 7-10 C�e�
Please feet free to add any additional cornmerat s you wish to make regarding your application.
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Applican __._.mW_......._..._.
t Signature t—e
Submit completed forms to: OFFICE OF THE CITY MANAGER
City,of Port.Angeles
321 E. 5b Street
PO Box 1150
Port Angeles, WA 98362
In compliance with the Americws with Disabilities Act,if you as ed special accommodations because of as physical
limitation,please contact the City Manager's Office at 417,4500 so appropriate arrangements can be made.
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