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CASS COUNTY GOVERNMENT <br />APPLICATION FOR BOARDS AND COMMISSIONS <br />B (ard ofinCpom(m~iys~s(io~n for whiyc~h ,ycou a1r/e a/p~pl(y~in <br />~U ~~ - It~(NJ L I l ~~i 1 V~~ V I I.F~J ~Ql~~ <br />Y NAME (Last, First, Middle) ~ Coun Legislative District Number <br /> ca.5 <br />Mailing Address <br />~~ City <br />J~OC' State Zip Code <br />.1" ~ ~V~ <br />C\ <br />Your Occupation -Title Business Phone Number Residence Phone Number <br />~~ <br />Name <br />Employer Addres City State Zip Code <br />Ffll 1( ATIr1Pl GNfI C~FNFRAI C)I IAI IFICATInNS <br />LEVEL NAME OF SCHOOL LOCATION No. Years <br />Attended Did You <br />Graduate? Major Course(s) <br />of Stud <br />High School ~-. '~1 <br />~J ~~ <br />College ^ 1 <br />V Ar <br />Trade/Business/Correspondence <br />Memberships in Organizations <br />and Offices Held <br />Indicate Dates Held <br />Volunteer Activities <br />Indicate if Pastor Present <br />Your Special Skills and <br />Qualifications <br />o~r~o~ni~~c n ~~++hreo ncrcnnc nor rci~4cr1 to Vl111 whom vnii haves known for at least one vear) <br />f\LI LI\LIY VI_.V Llol a,„VV v,VV..V <br />NAME , ..v. .v.v..... ... .~-., ....~... _-. .._.. _ -- <br />ADDRESS --_---- --- -- - - <br />PHONE NO. <br />Years <br />Ac uainted <br /> / ~ <br />~ <br />,~ V V ~ <br /> `~ <br />u <br /> V~1.,C/~ <br />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 <br />herein and the references listed above to give you any and all information concerning my qualificati nd any pertinent information they may have, <br />personal or otherwise, and release all parties from all liability for any damages that may result from fu h the me to you. <br />RETURN COMPLETED FORM TO: SIGNATURE <br />Cass County Commission ~ _~ ~ Q <br />PO Box 2806 DATE , <br />Fargo ND 58108-2806 <br />(Please attach a copy of your resume') <br />