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<br />REQUIRED INFORMATION
<br />OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID)
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<br />OCCUPATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR UNPAID)
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<br />EDUCATIONAL BACKGROUND (SCHOOLS ATI'ENDED, use attachment if needed)
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<br />Complete name of school. no acronyms Last grade level DiplomalDegree/Certificate Counle of study (optional)
<br />com leted AA BA, BS MA PhO etc.
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<br />Other:
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<br />PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED)
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<br />NOTE: This information is a matter of public record and may be published or reproduced.
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<br />By signing this document, I hereby state:
<br />lHA T I shall accept the nomination for the office indicated !lbove;
<br />TIIA T I shall qualify for said office if elected; and
<br />THAT all information provided by me on this form, including my occupation, educational and occupational background, and prior
<br />governmental experience, is tnJ.e to the best of my knowledge.
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<br />Candi
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<br />Date signer
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<br />Suppl . g false information on this fol'Dl may result in conviction of a felony with a fine of up to $100,000 and! or prison for up to five
<br />years. (ORS 60.715).
<br />No person shall file a nominating petition or declaration of candidacy for more than one lucrative office before the date of the primary election, un1ess
<br />the person first files a written withdrawal with the officer who accepted the filing (ORs 249.013(2)).
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<br />SEL 120 REV, \1/01 ORS 249.031
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