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13 <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND C0MMZSSI0N5 <br />If you are.an Orange County resident, at least 18 years old, and willing to <br />volunteer your time and expertise to your community, please complete and <br />return to: <br />NAME: <br />HOME ADDRESS: <br />ip Code~~'~ <br />TELEPHONE: (W} - (H) Z `•5l° <br />r <br />PLACE OF EMPLOYMENT: ~ -' /~S~tU ~ r~-~~~/~~S <br />,70B TITLE <br />ON REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS <br />~U WOULD LIKE FOR US TO CONSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />RESIDENCE: <br />Bingham Cheeks <br />Hillsborough Eno _._,~~ <br />Chapel Hill ~~ Little River <br />Cedar Grave <br />WE ASK YOUR HELP IN ASSURING DIVERSITY^OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: <br />Male ~ ETHNIC BACKGROUND: r. <br />Female ~ro,f African American Hispanic <br />• ~ Caucasian ~~G Other <br />Native American <br />DATE OF•BIRTH: • <br />PLEASE LIST (IN ORDER OF <br />WOULD BE WILLING TO SERVE. <br />3. <br />4. <br />PREFERENCE} THE BOARDS/COMMISSIONS ON WHICH YOU <br />County Commissioners' Office <br />P. 0. Box 8181 <br />Hillsborough, NC 27278 <br />