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<br />CASSCOUNTYGOVERNMENT <br />APPLICATION FOR BOARDS AND COMMISSIONS <br /> <br />RECEIVED <br />DEC~ 21 '.1 <br /> <br />Board of Commission for which you are applying: <br />Z 0 IV f- (Ill ~ ( () /11/ f r 71-: f'. c (r I <br /> <br />CA88 COUNTY COMMI8IION <br /> <br />o i'- 0- "..!f.(J I;' (l <br /> <br />YOUR NAME (Last, First, Middle) <br />~ I Nc \.. j} J/'l- L rr 5 I'll <br />Mailing Address <br />J to (y 0 { ~ r 1-/ .> r ~ 1; <br />Your Occupation - Title <br />I <. \~ C t~ / V , 1\/ ~ IVl G IL <br /> <br />County <br />(ifJ> <br />City <br />G 1I!l.. ,) 1\11: IL N 17 <br />Business Phone Number <br /> <br />Legislative District Number <br /> <br />State <br /> <br />Zip Code <br /> <br />). q , <br /> <br /> <br />(\( r) ,f if 0 <br />Residence Phone Nu ber <br />S- & :) J/ <br /> <br />1-( <br /> <br />l( <br /> <br />Employer Name <br />tV 0 rf. T I-r f., fl... "( f L fA fVl 8 11\ I , <br />Employer Address <br />{t 6t1..t~J1-1 <br /> <br />S II I'lL { <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br /> <br />/-- If If t' (; <br /> <br />,\; J/ <br /> <br /> <br />EDUCATION AND GENERAL QUALIFICATIONS <br /> <br />LEVEL NAME OF SCHOOL LOCATION No. Years Did You Major Course(s) <br /> Attended Graduate? of Studv <br />High School j.4 M€-J Td w./ AI U/>l !vi.:) r rJ\t'll /2--. V r-- j <br /> HI (;/"Y <br />College LA ty lJ C /...- I .l.-2- (yO <br /> '" JJ <br />Trade/Business/Correspondence <br /> <br />Memberships in Organizations {y t~ t( 0 A/ 6 I( I~ ( !( i-- O~jJr I O;~U- ).()(/tJ <br />and Offices Held <br />Indicate Dates Held iVl Pr N Y Y I;' J1 t? J /!J-J C /1 (I:' ,: <br />Volunteer Activities CLLrC ( r:r (,u( L f-( I (( ': 5 I IJ i 1\ I { <br /> o 1-' <br />Indicate if Past or Present <br /> ( 0 L( l '-( C ( L ,)/lJ I M '-:- IV/ g /=' IC {if Z Cl 1\1 Ji tJY ~ ((}>> <br />Your Special Skills and '\ 0' ;' ~ IT- It I( .:.. S I ,,' i J.t r 0 i-- 6 ~1. ON t/l () If.. 0 If AI 'Z /J 1"10 ^, <br />Qualifications J- ( <br /> A- fvV '- ,:-./;tf't:i( ..f/fj' J/(ILL) <br /> <br />L <br /> <br /> <br /> <br />ear <br /> <br />'-1&3 <br /> <br />I certify lhallhe facts conlained in lhis applicalion are lrue and correcl to the besl of my knowledge. I aulhorize invesligalion of all slalements conlained <br />herein and lhe references lisled above 10 give you any and all informalion concerning my qualificalions and any pertinenl informalion lhey may have, <br />personal or olherwise, and release all parties from all liability for any damages lhal m~y ~sult from ZiShing~e same I you. <br /> <br />RETURN COMPLETED FORM TO: SIGNATURE.'.~ / ) <br />Cass Counly Commission <br />PO Box 2806 DATE / 2- <br />Fargo NO 58108-2806 <br /> <br /> <br />(Please attach a copy of your resume') <br />