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t PLICATION FOR <br /> <br />.,: ~; ,:i~ :- ? <br /> <br />BOARDS AND COMMISSIONS <br /> <br />i]oacd or Cornrni~.lon for which you are applying: <br /> <br />Present Mailing Address (if different) <br /> <br />Your Occupation - Title <br /> <br /> FOR OFFICE USE ONLY <br />Appointed To <br /> <br />Qty <br /> <br />Busines~ Phone No. <br /> <br />Legislative Oistric~ Number <br /> <br />s' t /b tzlpc°de <br />State Zip <br /> <br />Residence Phone NO. <br /> <br />EDUCATION AND GENERAL QUALIFICATIONS <br /> <br />LEVEL <br /> <br />High School <br /> <br />College <br /> <br />Trad e~8 usines.~'Corrrespondence <br /> <br />Memberships in <br />Organizations <br />and Offices Held. <br /> <br />Indicate Dates Held <br /> <br />Volunteer Activities <br /> <br />Indicate if Past or Present <br /> <br />Your Special Skills and <br />Qualifications' <br /> <br />NAME OF SCHOOL <br /> <br />LOCATION I NO. Yea~ <br /> Atzended <br /> <br />I <br /> <br />Did You <br />Graduate ? <br /> <br />Major Course(s) <br /> of Study . <br /> <br />RE::= ....... c~'CES (lis: three pe~ons, not related to you, whom you have known for at leas( o, .... ,e ye=ch <br /> <br /> : Years <br />NAME ADDRESS pHoNE NO. Acquain[ed <br /> <br />(Please attach a copy of your resume') <br /> <br />I certify that the facts contained in this application are true and correct to the best of my knowledge. I authorize investiga- <br />tion of all statements contained herein and the references listed above to give you any and all information concerning my <br />c~ualifications and any pertinent information they may have, personal <br /> o~,,)amages I:hat: may result from furnishing the. same 1:o you. o~ otherwise. and. release all parties f~om ail liability <br />I ~/ (am not) at le~S('b(ghteen (18) years of age. <br /> <br />Cass County Commission -: :' <br />Box 2806 <br />Fargo. ND 58108 :......:. SIGNATURE <br /> <br /> DATE · <br /> <br /> <br />