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ATTACHMENT B <br /> <br />APPLICATION FOR APPOINTMENT TO <br />CITIZEN ADVISORY BOARDS AND COMMISSIONS <br />Please Pdnt or Type. <br /> <br /> LANE WORKFORCE PARTNERSHIP <br />Board or Commission <br /> (to represent a Eugene business on the board) <br /> John Lively <br />Name <br />Middle <br /> <br />HomoAddrass 86 We.~t D_ Rtr~pr: ~pr~n~lA. nP 97/~72-_~5!9 <br /> Street City Zip <br /> <br />Do you reside within the City limits? [] Yes [] No If yes, how long? <br />City Council Ward Neighborhood Organization <br /> <br /> 746-1103 343-3612 <br />Home Telephone Day Telephone <br /> <br />Occupation Directort ACT! Service and Support Place of Employment <br /> Best Software <br />Business Address <br /> <br />Fax Number (if applicable) 724-6211 E-Mail (tf applicable) John. Lively~bestsofrw~r. _ corn <br />How did you learn of this vacancy? []Newspaper--[~ Word of mouth [] Mail E-]Web Page <br /> Invited by the board~to apply <br /> <br />Other Source <br /> <br />OPTIONAL INFORMATION <br />The Eugene City Council suppods diversify and seeks to appoint persons who represent the diversify of the commun~y. By <br />providing ~he information below, you can help the City Council to know if the appointments match the diversity of the <br />community. Applicants are considered without regard to race, sex, color, national or,gin, age, religion, marital status, medical <br />condition, or disability. In some instances, however, appointment to certain boards/commissions may be based upon the <br />need to fill specific positions on the board/commission. <br /> <br />Please check the applicable boxes: <br /> <br />[] Male [] Female <br />I~ 18 and Under [-} 19 - 25 I-1 26- 35 [-J 36 - 45 [] 46 - 55 <br />[] 56 - 65 [] 66 and above <br /> <br /> [] African American [] American indian/Alaskan Native [] Asian/Pacific Islander <br /> [] Hispanic [] Middle Eastern [] Multkacial <br /> <br />[] White/European American <br /> <br /> Disability: [] Yes [] No If yes, please describe <br /> <br /> Fluentin languages other than English? [] Yes [] No Which language(s)? <br /> <br />Please ~omplete both s~des of ~is app~.~iO~ ~ ~ ~ ~ ~ ~ ~ ~'~ ~ ~ ~ <br /> <br /> <br />