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Special reasons for wishing to serve on the Board or Commission: <br />lis \I�ohltL n5— <br />What advisory panels, Boards/Commissions have you previously served on? <br />nCA <br />Please list any training or experience you have that would bp be eficial to serving on the Board or <br />��v�L1_'�`�-ccQU.��LI�il1C . <br />Are you available to attend board meetings during the day or evening M49 _1�)\anr�\ E <br />If no, please explain: <br />Please furnish two references who could speak to your qualifications for the desired appointment. <br />• Name:Phone: (H) — — (W) <br />Address:ki-b-EV!v� ��te City: �j�etnSb_vtate: WAI_Zip: <br />• Name: Phone: (H) (W) <br />Address: _ _ _ _ _ .__City —_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 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 r eived. <br />YOUR SIGNATURE:7:/ <br />date: <br />3u z1 <br />Please return completed form Board f 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 />