Agenda - 01-31-2012 - 4 - Laserfiche WebLink

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3 Content of this application is a matter of public record N.C. Public Records Law requires that any information you provide on this application for volunteer service be available for public inspection. 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 P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125 Fax: (919) 644-0246 Email: jjones@co.orange.nc.us NAME: HOME ADDRESS: CITY: PHONE: (Day) (Evening/late) (Fax) EMAIL: PLACE OF EMPLOYMENT: JOB TITLE: YEAR BECAME ORANGE COUNTY RESIDENT: IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: ^Bingham ^Cheeks ^Hillsborough ^Eno ^Chapel Hill ^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 MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: ^Male ^Female ETHNIC BACKGROUND: ^African American ^Caucasian ^Hispanic ^Native American ^Other DATE OF BIRTH: PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. WORK EXPERIENCE: 2. 3. Zip Code: VOLUNTEER EXPERIENC