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HomeMy WebLinkAboutApplication J Collins RECEIVED do°� 1202(1 e City of Port Angeles u ES A visor Board Application cr���� PORT a���� Parks, Recreation and Beautification Commission Applicant Name and General Information First MI Last Address City State Zip Home phone Work phone Cell phone E-mail address Certification and Location Information Areyou employed by the City of Port Angeles?..........................._.........._._____............_...._....._.._.._....__..................___.._..____......................_... Yes Nc Areyou a citizen of the United States?._.._..____..________...._.._.._.____......__...._..____.._.._..___...._._.___.._...._.._...._.._____________..__...._.._.. e No Are you a Registered Voter?......................... & No Are you a City resident?.___.._......_._..._. _. No If so,how long: ............... _,.. Do you own/manage a business in the City?........._.... Des No Do you hold any professional licenses,registrations or certificates in any No If so,please list: m 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: The City of Port Angeles Advisory Board A lication h Work or Professional Experience-List most recent experience first, or attach a resume --6111W1 �41 Employer Brief job description Employer Brief job description Employer Brief job description Education—List most recent experience first Ye No Institution/Location Degree earned/Major area of Study Graduated? c i i"t r, i S to Y°e115, 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 ri '; I M. Organisation/ location Group's pucrpos /objective P—CI�A�4— J Brief description of your participation f °b:� ►On S CIA, try-. try Organization/Location Group's purpose/objective Brief description of your participation ff�t�m be r , CAI I o- I?o r i IA d)qf Ids lil.fl C, , l�{�aur�� ZO i"7 e City of Port Angeles y fl, �� AdylsoLy Board licat on Parks,Recreation and Beatification Commission Applicant Supplemental Questionnaire 1. This Commission focuses can 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? -f" -Nutt.. I , 3. 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 pmk? Applicant S'ignatu-re ' Date Submit completed forms to: Office of the City Clerk Kari Martinez-Bailey City of Port Angeles 360-417-4634 321 East 5' Street kmbailey@cityofpa.us Port Angeles, WA 98362 In compliance:with the Aanericans 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 uatade.. "Phis document and all;attaached information is considered a public record and a'nay be distributed to members of the City Council for appointinent consideration. Additionally,it may becoine a part of a.City Council packet.