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81 <br />Page 1 of 1 <br />Eric Russell <br />Volunteer Application <br />Orange County Advisory Boards and Commissions <br />Name: <br />Name Called: <br />Home Address: <br />Phone: (Day) <br />Phone: (Evening) <br />Fax: <br />Email: <br />Place of Employment: <br />Job Title: <br />Year of OC Residence: <br />Township of Residence: <br />Zone of Residence: <br />Sex: <br />Ethnic Background: <br />Date of Birth: <br />Mr Eric Russell <br />5560 Field View Rd <br />Mebane NC 27302 <br />919 563 4959 <br />919 563 4959 <br />ejrussell@mebtel. net <br />Durham VA Medical Center <br />Staff Nurse, Emergency Dept <br />2000 <br />Cheeks <br />Male <br />Caucasian <br />9/18/1954 <br />Boards/Commissions applied for: <br />Orange County Emergency Services Work Group <br />Work Experience: <br />Intensive Care & Emergency Dept nurse since 1976. <br />Volunteer Experience: <br />Education: <br />ADN 1976 <br />Other Comments: <br />STAFF COMMENTS: Originally applied for Orange County Emergency Services Work <br />Group 1-3-2012. ADDRESS VERITIFCATION: Field View Road is OC Jurisdiction, <br />Efland Fire Tax, Cheeks Township. <br />This application was current on: 1/3/2012 7:15:34 PM Date Printed: 1/13/2012 <br />