Agenda - 03-24-2003 - 8.b.6 - Laserfiche WebLink

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FOR OFFICE USE ONLY 3/1 z/00 P. I e e 2 L.orrain� I�i, Passer VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to: ---- Orange County Commissioners, Office " " - - i P.O. Box 8181 Hillsborough, NC 27278 MA ( 2 2000 Phone (919) 245 - 2125; 245 -2129; 245 -2130; 732 -8181 1; Fax: (919) 644 -0246 • Email: nmartin&o.orange.nc.us L� NAME: 'r ca k n-r- " - r tc e r HOME AppRE SL 3 To 4 R-8 CITY: "-Q -C W NL C- Zip Code: 2. ^1 S `-E 'y-30- PHONE: (Day) (o�E�Q- 3 Xaa (Evening/late)�32i - '714 -X4 (Faz `f4 ~ 3 2 -L � EMAIL: Qc rV_vtcI r9 cats n.,n: I - ots - 4v=..4r__ . K -l;� . r1C - ct.S PLACE OF EMPLOYMENT: O'r's •%3c C- . JOB TITLE: �c IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: ❑ Bingham ❑ Cheeks ❑ Hillsborough ❑ Eno ❑ Chapel Hill X Little River ❑ Cedar Grove IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: ❑ Joint planning Area ❑ Extraterritorial Area ❑ Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBE SHIP BY AGE, GENDER AND RACE, BY ANSWERING THE-FOLLOWING QUESTIONS: ❑ Male A,Female ETHNIC BACKGROUND: ❑ African American,xCaucasian E3 Hispanic 13 Native American 13 Other DATE OF BIRTH: % / r 3 PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDWCOMMISSIONS ON WHICH YOU WOULD- BE- WILLiNG.TO SERVE. ._.._ _.._...._ 1. Rcc r- e-- Ar;-in t �sc lzZ 2. - 3. _. WORK EXPERIENCE: -, -r 't 6,-- -L_n e. V-n c U e A c, 4- ec' C-V% e-1- I n v-,a =% e, C.o U n -t- 4 S c_-l-% ,ft l s as S V «r -t i -E �► ti+ nn us �� A a CbM�^�Ltr1►'�'I•GS ZV1 zC{�eals Sj-� G CoOYeIly- adm��- of . rbae _ VOLUNTEER EXPERIENCE: l�dv�sor -U, Ba-Mra a-� �tcrc ,:o ova _ �4r- k5 Q ►n .a r^ b Gr �_ L' tr►a r r_ .i