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<br />07/16/2004 01: 32 PM <br /> <br />APPLICATION FOR BOARDS AND COMMISSIONS <br /> <br />, ,.-'. ,..,. .. <br /> <br />Your Occlolpiltion - Title , <br /> <br />Emplav-r Name <br /> <br />¡Vl~ '( cJ fIl <br />G. .,... r ð,.. <br /> <br />EmplOVtf AddteIs <br /> <br />LEVEL <br /> <br />EDUCATION AND GENERAl QUAUflCATIONS <br /> <br />High Sd1ooI <br /> <br />College <br /> <br />1',.118'( ,,:- --.11"- \ trf" II.' A <br /> <br />Membetships in <br />Organizations <br />and Offices Held. <br />Indicate Dåtes Held <br />, <br /> <br />Volunt,eer Activities <br />Indicate if Past or Present <br /> <br />Your Special Skills and <br />Qualifications' <br /> <br />count~ <br /> <br />City <br /> <br />fit.1C6# <br /> <br />Cit)' <br /> <br />IUJin.. Phone Na, 3 , " <br />...." I-' v <br /> <br />r II ¡U.. ~ <br /> 0tJ <br /> <br />LOCATION <br /> <br />NAME OF SOiOOL <br />~~~ .'~ ,\,~ B\S~lIt <br />tr~~ ({!'f,t~. W <br />MJ 'PI'" ~ 5t t)ê V f6.¡ 2-e '" ..., ~ I'f T . <br /> <br />City of Fo'go - Commission <br /> <br />2/2 <br /> <br />FORO~F CEUS£ONlr <br />AppOinted To <br /> <br />DATE <br /> <br />Letis&.tiw! V.r Mum"" <br />S~ . ZiP~T¿ClL <br /> <br />Sate <br /> <br />Zip c.oct. <br /> <br />I 'oa<o1 0< ComV;~!;:, ~Ch ë;~~ (561'" ;I!. II) <br /> <br />YOUR"'A~(Yst.Fjrst.Middl~ /2 - fA.) <br />t\oll~"S, «J~ <br />pe;_n'~Mailj7Add/ey <br />. -¿..."3 t..."...t\-C. lIt.ve:?" " <br />P,es.At MaUlng Mdreu [If dltf.,.nt) <br /> <br />[gte <br /> <br />No. VealS <br />Attended <br />&.( <br />'( <br />Z- <br /> <br />- <br />Residence ;"hone NO..A/ ~ Î <br />'%- .. ç --w- <br /> <br /> SUlte <br /> <br /> ztpCode <br /> <br />Oid YOtI <br />CifaduatIo 7 <br />y~ <br />,,~ <br />ý5- <br /> <br />..., Coutse(s) <br />olStucir . <br /> <br />-... <br /> <br />~ -I&.s <br />MINJ.-~ <br /> <br />NAME <br /> <br />REFERENCSS (list three persons, not related to you, wham vou have known for at least one year.. <br /> <br />Vears <br />Acquainted <br /> <br />ADDRESS <br /> <br />PHONE NO. <br /> <br />I certify that the facts contained in this application are true and «<reet to the best of my knowledge. I authorize in\/estiga- <br />tion of all statements t:ontained herein and the referencG Ii$~ed .bove to give yOu any and all information concerninq my <br />qualifications and any pertinent information they may have, P«SOnal or otherwise. and release all parties from all liabIlity <br />for any damages that may result fro,n furnishing the same to you. . . <br /> <br />I (am) I (am not) 8tl.asteÎghteer'l~18)yearsofage. ~. . ¿ <br />RETURN COMPI..ETED FORM TO: <br />Ci1I5S County Commission . ~ <br />Box 2 806 <br />Ftrgo. NO ~108 SIGNA TUR{ <br /> <br />7-t.Ç' ,.'ZP'L <br /> <br />(Pleèl~ attach a copy of ~ur resam~) <br /> <br />" - ';' .. <br />