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]Pik <br /> Kittitas County Beards, Committees, & Commissions 4 <br /> Application Form <br /> T hank you for your interest in serving on a Kittitas County board,committee,and/or commission.Please complete this <br /> application and return it to the Commissioner's Office. If you wish,you may also attach a resume or additional documentation <br /> to support your application. <br /> PLEASE NOTE.This document is considered a public record and is subject to disclosure under the Public Records Act{RCW <br /> 42.56.250). Personal addresses,phone numbers,and email addresses will be redacted. <br /> Please list the board(s),committee(s),or commission(s)for which you would like to be considered: <br /> *Public Lands Advisory Committee <br /> • <br /> APPLICANT INFORMATION <br /> NAME DISTRICTYOU RESIDE IN <br /> Joseph L. Bl azek 0 One C1 TWO R Three <br /> EMAIL ADDRESS. PHONE NUMBER <br /> Joeblazeki @gmail.com 509-899-6535 <br /> HOME ADDRESS1913 Green Parks Dr. Ellensburg, WA. 98926 <br /> MAILING ADDRESS(IF DIFFERENT) <br /> EDUCATION <br /> TYPE NAME OF SCHOOL MAJOR DEGREE/CERTIFICATE EARNED <br /> High School <br /> College or University U of Washington Forest Mgt Forest Resources Mgt <br /> Technical,Trade,Other <br /> WORK HISTORY <br /> CURRENT OR MOST RECENT EMPLOYER JOB TITLE <br /> Wash State Dept of Nam Resmrices District fXAgr <br /> EMPLOYMENT DATES EMPLOYER PHONE NUMBER <br /> From: 9/46/79 To: 12/15/15 509-925-851 o <br /> REFERENCES <br /> REFERENCE 7 <br /> NAME RELATIONSHIP TO YOU <br /> Gary Berndt manager <br /> EMAIL ADDRESS PHONE NUMBER <br /> 5o9'874-5593 <br /> REFERENCE 2 _ <br /> NAME RELATIONSHIP TO YOU <br /> EMAIL ADDRESS PHONE NUMBER <br />