Orange County NC Website
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-0 ~ • ! :; <br />c, <br />FOR OFFICE USE ONLY ` v`rf ~'~- <br />~ ~~:C~ ~ L~ ~ ~u`~ <br />~ ~_ .1 <br />a..~ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMIISSIONS '~'`^ ~_.,_ <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and ,r' <br />expertise to your community, please complete this application and retuir~n to: ~~''~ <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644-0246 Email: ncglover@co.orange.nc.us <br />NAME: 1 ~~R~ ~~'1~C.b~LOs - - ... <br />HOME ADDRESS: ~~ d~ ~~y I tt~~ J '~~ ( <br />CITY: tL, }~q ~~.. ~) L Zip Code: ~~ 5~ <br />PHONE: (Day) ~~~ "O~~b (Evening/late) ~~~2_::(Fax) <br />EMAIL: ~ qf2~ 0 P CO S ~ M~ BUJ f ~/N ~. C~ <br />PLACE OF EMPLOYMENT: MAlL~-mQGaS CANS~.V~JOB TITLE <br /> <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF }ESIDENCE: <br />Ingham ^Cheeks ^Hillsborough ^ Eno ^Chapel Hill ^Little River ^Cedar Grove <br />IN ADDITION, PLEASE INDI TE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />^Joint Planning Area xtraterritorial Area ^Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF M ~ BERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: ale ^Female <br />ETHNIC BACKGROUND: ^African American aucasian ^Hispanic ^N tive American <br />^Other DATE OF BIRTH: ',3 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. b w ~~~ 2. <br />3.. <br />WORK EXPERIENCE: COAIS'1'(2.yG~"j3/U , ~'l/1K,N[T1J/Z„Lr' ~ (~ ~L.E.'n, '~Vi2+~!'jJ~C-E <br /> <br />VOLUNTEER EXPERIENCE: L-'' ~ L , Utn1A'SA ~/~RR~:>v~~ <br /> <br />