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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 />Please list any, training or experience you have that would be be cficial to serving on the Board or <br />.ommission: _ C.i�t-` 13 <br />Are you available to attend board meetings during the day or evening M-F?����(lil� ~ e <br />If no, please explain: _ U <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: (7t� -1f ^�O Phone: (H) _ (W) <br />Address:Ut �a �(� ��{e_ City: '�C:A\ _qtate: WA_Zip: <br />• Name: Phone: H W <br />Address:.. _ _ .. -- - -____--City --- State: Zip: _ 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 interest, the <br />Board of County Commissioners may desire to conduct an interview. We will retain your <br />application for 2 years from the date it is re •eived. <br />YOUR SIGNATURE: Date: A %3� ' 2 <br />Please return completed form Board t' Kittitas County <br />Commissioners 205 W.5th, Room 108 <br />Ellensburg, WA 98926 <br />509.962.7508 or bocc@co.kittitas.wa.us <br />PLEASE NOTE: ALL APPLICATIONS SUBMITTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />