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Special reasons for wishing to serve on -the, -Board or Commission: <br />What advisory panels, Boards/Commissions have you previously served on? <br />14 / I <br />c� �/ <br />Please list any tra' ing or experience ou have that ould be beneficial to serving on the Board or <br />Commission: r " <br />r4 y Ll <br />Are you available to attend board meetings during the day or evening M -F? Yes [ ] <br />If no, please explain: No <br />Please furnish two referenceesj who could speak to your qualifications for the desired appointment: <br />■ Name: V ► ►C !j Phone: (H) ►S a2of �,► <br />J�'6 (W) <br />Address: �!d/ �e*f4& City: State: �Gi Zip; j` <br />Name: 0 _%��c �27.ZIPhone: <br />�l <br />Address:C �� <br />I ci�l'?�[ %� _City ��� �S State•[ `Zip: <br />Your application will be.placed with others interested in serving on the same board or commission. <br />When a vacancy occurs on the Board/Commission in which you have indicated an intergst,..the <br />Board of County Commissioners may desire to conduct an interview. <br />YOUR SIGNATURE:3 _ O�� <br />IDate: <br />Please return completed form to: Board of Kittitas County Commissioners <br />205 W. 5e41 Room 108 <br />Ellensburg, WA 98926 <br />509.962.7508 FAX: 509.962.7679 <br />PLEASE NOTE: ALL APPLICATIONS SUBMITTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />