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!Q <br />Page 1 of 1 <br />Jeanette Clark <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 />Township of Residence: <br />Zone of Residence: <br />Sex: <br />Ethnic Background: <br />Date of Birth: <br />Ms. Jeanette Clark <br />221 Rencher St Apt 3 <br />Hillsborough NC 27278 <br />919-620-8662 <br />732-7856 <br />6208662 <br />Central Family Care <br />Supervisor in Charge <br />Hillsborough <br />Hillsborough ETJ <br />Female <br />African American <br />7/8/1955 <br />Boards/Commissions applied for: <br />Nursing Home Community Advisory Committee <br />Joint Orange Chatham Community Action Agency <br />Work Experience: <br />I have been in the medical experience for about 12 yrs. I am a certified nurse assistant, <br />and a certified medical technician. I have nursing home and adult care home <br />experience. I supervise ~a group home now for mental residents <br />Volunteer Experience: <br />I have no volunteer experience but I have done outreach before and I have a certificate <br />for a class I took as an outreach worker. <br />Education: <br />GED <br />Other Comments: <br />STAFF COMMENTS: Originally applied for Nursing Home CAC and Adult Care Home <br />Community Advisory Committee and JOCCA. ADDRESS VERIFICATION: 211 Rencher <br />St is in Orange County in Hillsborough Township in Hillsborough ETJ. <br />This application was current on: 2/23!2005 Date Printed: 10/5/2006 <br />