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<br />P (~~~ <br />FOR OF9-ZCE USE ONLY <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AhID COMMISSIONS <br />li you are an Orange County resident, a1 !oast 18 years old, and willing to volunt ur t~mo Ana _ <br />ex rtise to our communlt , please campletc this a Ucation and return tv: ~ `~~ <br />. ~ , .. ,; <br />Orange County Commissionsrs' Clifice <br />P.O. Box 8181 MAY 2 8 203 <br />Hillsborough, NC 27278 <br />Phone {819} 245-2128; a45-2128; 245-27 30; 732-8181 ~._ __ ~ ¢ ' <br />Fax: (919y 6d4-0246 • Email: ncglover~co.orange.nc.us 6 <br />f <br />NAME: ~ ~ ~ I S (S~ I-t ~ (~Yl-GLIB <br />HOME ADDRESS: yI"Z-I ~eu~arac~~ 1~ r <br />CITY: Z f p Code: 2~' lJ <br />PHONE: (Day)~~ ~Dy -~+52~- (EveningJlate} {Fax} <br />EMAIL: - <br />PLACE OF EMPLOYMENT: <br />JOS TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDIC/~TE YOUR TOWNSHIP <br />OF RESIDENCE: <br />CBingham heeits ^Hillsborough ^ Eno CChapel Hill CLittls Rlvsr GGadarGrovs <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />CJoint Planning Area ^Extraterritvrial Area CTransition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERS~HIP~Y AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLO~ING QUESTIONS: ^Male ~emals <br />ETHNIC BACKGROUND: t>~Afrlcan American Caucasian OHlspanic CNativr~ American <br />ClOther DATE OF BIRTH: <br />PLEASE LIST {IN ORDER OF PREFERENCE] THE BOARD&lCOMMISSIONS ON WHICH YOU <br />WO DBE 1tiiLLiNG TO SERVE. <br />WORK EXPERIENCE: Ptie.~-mav~.~- ~a.~~\ ~,~v~'c~ - mLr (/}sct~J <br />VOLUNTEER EXPERIENCE: ~T~ ~ h ~' S~'lm <br />(d,il~ C.. _ E~ S p ~ -1-t~ S ~i.\.tir~ t ~~ (J~tu ~ ^Yc.. - <br />O~~cv~1 -~~v <br />OC-3(~~ Jy <br />~~ ~ ~c-~~~.e.tir /M~AD~,~c`g S~i$~a3 <br />Sc ~ ~-~.~~ur~~ ~ <br />