HomeMy WebLinkAboutJake Jacobsen Application 0728/2018The City of Port Angeles
Advisory Board Application
Parks, Recreation and Beautification Commission
Applicant Name and General Information
First MI Last
1X30 4e— PoCC A&eAc,s: A
Address City State Zip
-,56c) NIA ( .... )
Home phone Work phone Cell phone
E-mail address
Certification and Location Information
Areyou employed by the City of Port Angeles?.................................................................................................................................................................. Yes No
Areyou a citizen of the United States?........................................................................................................................................................................................... Yes No
Areyou a Registered Voter? ................... .......................................... _............ ..................................................... _...................... .................................. _..... -.................. Yes No
Areyou a City resident? ..................................... _......................................................................................... .............. ............................................................... ................... es No
Ifso, how long: .......................... ................................................................................................................................................................................................................._.......... Y'e°
Do you own/manage a business in the City`?......- .................... ................... ............................................. ............... _............... ....... ............-....................... Yes No
Do you hold any professional licenses, registrations or certificates in any field?.............................................................................. Yes No
If so, please list:
Are you aware of any conflict of interest which might arise by your service on the advisory board that you are applying for?
If so, please explain:
F, AUG 2'82010
ICOR i Al
I -Y CLER
The City of Port Angeles
Advisory Board Application
Work or Professional Experience - List most recent experience first, or attach a resume
Employer
Cl e
Brief job descriptio
Employer
ra
Brief job
Employer
Brief job description
Education — List most recent experience first
re J,Ck-� -'
Yes No
lnstitution/Loca`Cion Degree earned/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
Organization/Location
Brief desdriptildn of your participation
Organization/Location
Brief description of your participation
purpose/objective
Group's purpose/objective
The City of Port Angeles
Advisory Board Application
Parks, Recreation and Beatification Commission Applicant Supplemental Questionnaire
1. This Commission focuses on three areas: parks, recreation, and beautification. If you had to choose, which of these three areas
would be the primary one in which your interests and experience would be aimed?
2. What is your favorite City of Port Angeles parks and recreation facility and why?
Think of a Port Angeles park you visit. What would you do, or like to have done, to improve your experience? What do you
love about this park?
P , F
k
Applicant Signature Date 1
E
Submit completed forms to:
Office of the City Clerk
City of Port Angeles
321 East 5111 Street
Port Angeles, WA 98362
Jennifer Veneklasen
360-417-4634
jvenekla@cityofpa.us
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 360-417-4500 so appropriate arrangements can be made.
This document and all attached information is considered a public record and may be distributed to members of the City
Council for appointment consideration. Additionally, it may become a part of a City Council packet.
IN