HomeMy WebLinkAboutBoard Application BlankName:Date:
Mailing Address:Home Phone:
City:State:Zip:Work Phone:
Email:Cell Phone:
Employer:Occupation:
Organizations/Affiliations:
What community activities have you participated in during the past five years?
I am applying to
serve on:
I reside in Commissioner
District Number:
Board or Commission
Please provide a brief background sketch including education, job experience, skills, hobbies and special areas
of interest:
Jefferson County
BOARDS and COMMISSIONS
Volunteer Application/Statement of Interest
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BOARD and COMMISSIONS VOLUNTEER APPLICATION/STATEMENT OF INTEREST Page 2
Why are you applying for this appointment?
What special skills, knowledge, or experience do you have to contribute to this Task Force?
Are you serving, or have you served on any citizen advisory boards, commissions, committees or task forces? If
yes, please list board/committee names and dates served:
What problems, issues or concerns do you see facing this particular Task Force, and how would you propose
they be addressed?
BOARD and COMMISSIONS VOLUNTEER APPLICATION/STATEMENT OF INTEREST Page 3
Additional information you would like to provide about yourself:
Please return to:Jefferson County Administrator's Office
PO Box 1220
1820 Jefferson Street
Port Townsend, WA 98368
What limitations, if any, are there on the time you would be available for meetings and other activities? How
much time are you able to devote to the duties of this Task Force?
I understand that this appointment will entail my attendance at meetings and participation in activities of this Task Force. All of
the information on this application is true to the best of my knowledge.
Date Signature of Applicant
It is desirable for Advisory Board and Commission members to have a broad collective knowledge and interest
in various ethnic, religious, cultural, educational and community views. Describe your strengths in this area: