f. Comm policy amended-appt - Laserfiche WebLink

CASS COUNTY GOVERNMENT RECEIVED APPLICATION FOR BOARDS AND COMMISSIONS DEC u 0 2013 Boar of Commission for which you are applying: CASS COUNTY COMMISSION d4t/1,41-04/ Z J v"p 4-0,441 YOUR NAME(Last, First, Middle) ,},� County Legislative District Number /r1,cA /2//, &.///n 0_43. / I Mailing Address I City State Zip Code /5o.�-O/ -.h. -#/03 ',^'/ ,/D 27/03 YoOcp tion-Title Busine6sQPhone Number Residence Phone Number 4'.,d hrd ACM/:,/e, /rl1 70I CC- 7-t9-1 3 N )k Employer Name / Email Address � -t;/f—ii)7,43,0/ a/lestc.4rdN , A.-0 ('®h'L. Employer Address City State Zip C•:e EDUCATION AND GENERAL QUALIFICATIONS LEVEL NAME OF SCHOOL LOCATION No.Years Did You Major Course(s) Attended Graduate? of Study High School / GA dt r' /%6 I i e'. /1/Vidbu j/0 , � y l� College Trade/Business/Correspondence Memberships in Organizations te r ,;,,!ss t ,L 0/4, _toop, - and Offices Held `,/ , _ 3e1-- ,w,� Firs7' res60rlan Uiur Indicate Dates Held NRI¢ Volunteer Activities 3,9 61-vthvr1g-el''Q' _AP- /S tiled /I/aHs71,r - 1:11.42.4.1- Indicate if Past or Present Fes-ro" AreAt-'°'`'� / r- NQSQ3 Q Ili mn i f.'CoirNdit f.cis/,eesc1/�d JS't,0.rav`®S #5 y 6/VIA pr / o 41.4 ajiJ;l..ec or c -As?- Your Special Skills and p Qualifications / 20191 e d At 4f sf /YI Nip 9 ,`47 o4-ii- REFERENCES(List three persons, not related to you,whom you have known for at least one year) NAME ADDRESS PHONE NO. Years Acquainted X raM Thee 0 4-.R.-rt rfr 701 -341 • 4,43'7 30.1- Aoq ori / 'Iii e army/s `is..1 ‘7j4> - ys c•y AI� �rL a e A%L & F�el0 701 - 371 -c1ib / - I certify that the facts contained in this application are true and correct to the best of my knowledge. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my qualifications and any pertinent information they may have, personal or otherwise,and release all parties from all liability for any damages that may result fr m furnishing the same to you. RETURN COMPLETED FORM TO: SIGNATURE ,/ •e-y-' Cass County Commission j PO Box 2806 DATE / -// ` [ /3 Fargo ND 58108-2806 (Please attach a copy of your resume')