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_~=. - y ~~ <br />~~ i- <br />. _. p 1/2 Ruby W. Tilley <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br />if you are an Orange County resident, at least 18 years old, and willing to volunteer your time anc <br />expertise to your community, please complete and return to: n ~ ~ 2 ~ C~/1~ ~--y <br />Orange County Commissioners' Office <br />P. O. Box 8181 <br />Hillsborough, NC 27278 <br />~- <br />NAME: ~ ~ <br />HOME ADDRESS: a 70/ ~~ ~~'"~ ~' ~~ <br />7rI.r.C,Go >'1 C Zip Code a 7~ ~ <br />TELEPHONE: <br />EMAIL <br />(H) '~~ 3a ~ 3 9 ~ s ~ M-) ~ ~ (F~) <br />PLACE OF EMPLOYMENT: Q~~~ dOts-wGC. ~ ~~ .f71~~'II~----- <br />JOB TITLE: ~~~~'~~~~ ~''~-~~ <br />ON REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE ANDIOR SKILLS YOU <br />WOULD L KE FOR S TO CONSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />RESIDENCE: Bingham Cheeks _____~ <br />Hillsborough ~ Eno <br />Chapel Hill Little River <br />Cedar Grove. ~., <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />JPA (Joint Planning Area) <br />EA (Extraterritorial Area) <br />TA (Transition Area) <br />_WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP !3Y AGE, GENDER AND RACE, BY <br />ANSWERING THE FOLLOWING QUESTIONS: <br />Male ETHNIC BACKGROUND: <br />Female -/ African American Hispanic <br />DATE OF BIRTH: Caucasian ,_ /~ Other <br />q_a,~j _ g G Native American <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD <br />BE WILLING TO SERVE. ~ ~~ J ~~ <br />1. 1 d.ac.ZQ ~ j`~~''9 <br />2. <br />3. <br />