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<br /> <br /> <br />AA <br />PPLICATION FOR PPOINTMENT TO <br />CABC <br />ITIZEN DVISORY OARDS AND OMMISSIONS <br /> <br /> <br /> <br /> <br /> <br /> <br />Name of Board, Commission, or Committee <br /> Eugene Toxics Board <br /> <br /> <br />Please print or type <br /> <br /> <br />Name Stephen Richard Flanagan <br /> <br />First Middle Last <br /> <br />Home Address 3405 Storey Blvd. Eugene OR 97405 <br /> <br />Street City Zip <br /> <br />Home Telephone (541) 543-5804 Daytime Telephone (541) 688-3155 <br /> <br /> <br />Do you reside within the city limits? Yes No If yes, how long? 1 year <br />?? <br /> <br /> <br /> <br />City Council Ward 2 Neighborhood Organization Crest Drive <br /> <br />Occupation/Place of Employment University of California, Davis / telecommuter <br /> <br />Business Address __________________________________________________________________________________ <br /> <br /> <br />Fax number (if applicable) _________________________ Email (if applicable) bonmot.srf@gmail.com <br /> <br /> <br />How did you learn of this vacancy? Newspaper Word of Mouth Mail Web page <br />???? <br /> <br />Other source __________________________________________________________________________________________ <br /> <br />NOTE: Information consisting of home addresses and phone numbers may be exempt from disclosure per ORS 192.502(3). <br /> <br />OPTIONAL INFORMATION <br />The Eugene City Council supports diversity and seeks to appoint persons who represent the diversity of the community. By <br />providing the 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 origin, age, religion, marital status, <br />medical condition, or disability. In some instances, however, appointment to certain boards/commissions may be based upon <br />the need to fill specific positions on the board/commission. <br /> <br /> Male Female <br />?? <br /> <br /> 18 and under 19-25 26-35 36-45 46-55 56-65 66 + <br />??????? <br /> <br /> <br />? African American ? American Indian/Alaskan Native ? Asian/Pacific Islander ? Hispanic <br />Disability? Yes No If yes, please describe _______________________________________ <br />?? <br /> <br /> <br /> Middle Eastern White/European American Multiracial <br />??? <br /> <br /> <br /> <br />Disability? Yes No If yes, please describe ______________________________________________ <br />?? <br /> <br />Fluent in language(s) other than English? Yes No If yes, please list ____________________________ <br />?? <br /> Z:\CMO\2008 Council Agendas\M080811\S0808112D-attA.doc <br /> <br />