HomeMy WebLinkAboutFrench ApplicationThe City of Port Angeles
r-- E-t Utilitv Advisorv Committee Apnlication
Utilitv Advisory Committee Application
Applicant Name and General Information
FPosition appl-ving for (check one):Citizen at-large
Industrial Customer Representative E Licensed Care Faciliq Representative
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First
Address
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Cit_Y
Last
State
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Home phone Work phone Cell phone
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E-mail address
Certification and Location Information
Are you employed by the City ofPon Angelesl
Are you a citizen ofrhe United States
Do you live in the Ciry of Pon Angeles limits? .---------
Do you hold any professional licenses, regisrations or cenificates in any field?...
Yes or No
@&No
No
No
I[so, how long:----
No
No
lfso. please list:
explain
any on rct of rnteresl
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ml by your service on the Utility Advisory Committee? [f so- please
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The City of Port Angeles
t-- EJ Utilitv Advisorv Committee Anplicati on
Work or Professional Experience - List most recent experience first. or attach a resume
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Employer
Briefjob description
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Employer
Briefjob description
Graduated?
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Institution'
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Degree eamedrMajor area ofSrudy
No
Graduated?
Yes No
lrlstitution/ Location Degree eamedMajor area of Snrdy Graduated?
Yes No
InstitutiorL Location Degree eamed/Major area of Study Graduated'l
Charitable, Sociat and CMc Activities and Nlembersttps - List major activities you have participated in
during the last five years
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Organizatior/Location Group's purposeiobjective
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Brief description ofyour partic ipation
Brief description of your panicipation
Group's purpose/objectiveOrganizatio& Location
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Education - List most recent experience first
The City of Port Angeles
r. E.:t Utility Adviso rv Committee App lication
Questions
L why are you interesled in serving on the Port Angeles Utility Advisory Committee l
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2. what i your background or experience you think would help you in serving on the Committee l
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3, What is your understanding ofthe responsibilities ofth€ Committee?
4.P fee fiee to add any additional comments you wish to regarding your application
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expenence.wledge. or perspective do you bring?
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licant S ature:
Submit completed forms to:Oflice of the City Clerk
City of Port Angeles
321 East 5'h Street
Port Angeles, WA 98362
Date:
Kari Martinez-Bailey
3604t74631
kmbaileygcityofpa.us
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ln complianc'e with the Americans with Disabilities Act, ifyou need special ac'commodations because ofa physical limitation, please contact
the Ciry Manage's Office at 360-417-4500 so appropriate arrangerncnts can be made.
This documenr and all atrached inlbrmation is considercd a public rc:cord and may be distributed to membeni ofthc City Council for
appointmcnt consideration. Additionally. it may become a pan of a City Council packet.
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