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/Z- <br />Page 1 of 1 <br />Johanna Jensen <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 />Ms Johanna Jensen <br />2201 Baycourt Trail <br />Hillsborough NC 27278 <br />225-1925 <br />24,5-1637 <br />jjensenj@mindspring.com <br />Medical Technologist <br />Township of Residence: Hillsborough <br />Zone of Residence: <br />Sex: Female <br />Ethnic Background: Caucasian <br />Date of Birth: 9/19/1963 <br />Boards/Commissions applied for: <br />Adult Care Home Community Advisory Committee <br />Work Experience: <br />Duke University Hospital, Medical Technologist, 5/1990- present <br />Volunteer Experience: <br />Education: <br />BS in Medical Technology, Medical College of Virginia <br />Other Comments: <br />STAFF NOTES: 10/03 Original appl. For CFW; ACHCAC. ADDRESS VERIFICATION: <br />2201 Baycourt Trail, Hillsborough is in Beckett's Ridge Subd, in Hillsborough City Limits, <br />In Hillsborough Township. MOAD/ncg. <br />This application was current on: 11/9/2003 Date Printed: 1/15/2004