Orange County NC Website
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<br />V <br />~ ~ ~ ~ FOa OFFICE USE ONLY r ~~ <br />v F fs K~~st~n~ ~o~~e .__._. <br />.:, <br />VOLUNTEER APPLICATION ' ~ { <br />;ORANGE COUNTY ADVISORY 60ARDS AND COIIAMISSIONS ~ .. ~' -~ "3 '' <br />~~i ' <br />ff you are an Orange County resident, at least 98 years old, and willing to volun <br />expertise to your dommunity. please complob this application and rstum to: <br />Orange County Board of Commissioners' Office • <br />I P.O. Box 8181 <br />Hillaborcugh~ NC 27278 <br />Phone (919) 245.2925; 2dS•2129; 245.2130; 732-8181 <br />Faz: (919) 6440246 • Email: ncglover~co.orange.nc.us <br />.~ <br />NAME: ~r 1 Ski v~, o0re, __ <br />HOME <br />Zip Code:.,~~r21 ~' _ <br />CITY: <br />PHONE:(Day)~~~ a`~~-'~'4~ (Lveningllate)(9,~9~,~4~-`i?N'9 (Fax) ,._._.~ <br />EMAIL: <br />PLACE O! EMPLOYMENT:~O~(~ ih AGyiOB TITLE: M C' Q~C.(~G4~ Pr'b~ ~ rd . <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: i <br />O Bingham O Cfioeks O Hillsborough O Eno L~Chapei Hill O Little River U Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O .Joint Plarming~llrea O Extraterritorial Area O Transition Araa <br />.~ <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY A[iE, MENDER AND RAGE, <br />BY ANSWERING TFIE FOLt.OWINO QUESTIONS: O Mols ~emate <br />ETHNIC BACKGROUND: O African American C~'Caucasian O Hispanlo O N five American <br />O Other DATE OF BIRTH: _,~~.^ <br />PLEASE LIST (IN bRDER OF PREFERENCE) THE BOARDSlCOMMISSIONS ON WHICH YOU <br />WOULD BE WILL~G TO SERVE. <br />1. _J11~La!')~- . ~~r15_____ 2. r-da• ~,}~usir~ 3. ~•ior~~~lrl rt h <br />WORK EXPERIENCE: ~21~,5.~..S,e!'~ rp ~s>~ -~C,y~c{~~ _,~_,-„ <br />- _~ ~.~~. <br />I <br />VOLUNTEER EXPERIENCE _ _„~ ~~__ _ <br />~- (~6Y1'Fld '~ <br />