Orange County NC Website
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3 <br />FOR OFFICE USE ONLY <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to, volunteer your time and <br />expertise to your community, please complete this application and returli tM" = <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NO 27278 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 844-0246 a Email: nmartin@co.orange.nc.us <br />NAME: s c %?s <br />HOME ADDRESS: _ /d 5/•?I Cc&o/ e <br />CITY• Zip Code: .? 95`?G <br />PHONE: (Day) (9/9) 7P-3rsa r,/-Os-(Eveningflate) 911-77!!,L ?(Fax) <br />EMAIL: <br />PLACE OF EMPLOYMENT: JOB TITLE: Z,;- ?m,rtieu *• o? /? <br />IN ORDER TO ASSURE-COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP' <br />OF RESIDENCE: <br />? Bingham ? Cheeks 13 Hillsborough 17 Eno W Chapel Hip ? Little River 0 Cedar Grow <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />? Joint Planning Area 17 Extraterritorial Area 17 Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: L! Male CI Female <br />ETHNIC BACKGROUND: ID African American 0 Caucasian ? Hispanic 17 Native American <br />17 Other DATE OF BIRTH: PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD. BE WILLING TO STE VE. <br />2. 3. <br />WORK EXPERIENCE: <br />J-,, <br />VOLUNTEER EXPERIENCE: ?a•-/•-R /,?&,,(.? Gjly??/ P? 4 ?l,/J, c? ?j e