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kLICATION FOR APPOINTMENT TO · <br />;IZEN ApVISORY BOARDS AND COMMISSIONS <br /> '~ :~. or Type <br />:d or Commission ,~___. <br /> <br /> First Middte Last <br />,e Address //~:¢ ~~___~ ~,~' ~~ <br /> · Stmet City ~ Zip <br /> <br />~uncil Ward Neighbomood Organ~on <br /> <br />~pation ~ ~ ~~¢~ . Place of Employment <br />inessAddress ¢~0 C~~~ ~O~ ~¢ ~¢ ~ ¢ - <br />Number (if appli~ble) ~¢) ¢~/-~~ E-Mail (If applicable) <br /> <br />r did you learn of this va~nc~ ~ Newspaper ~ Word of mouth ~ Mail ~Web Page <br /> <br /> [ III I <br /> <br /> IN~RMA TION <br />Eu~,~e C~ Coun¢l supers dive~y and seek~ to ap~i~t ~ons who mpmsent ~e d~e~ of the commun~y. By <br />~ ~e info~a~ ~low, you ~n help ~e ~ ~uncll to ~ow ~ ~e ap~l~menls mat~ lhe d~em~ of fha <br />~un~. ~plicanls am ~nsidemd ~h~ ~a~ Io ~, sex, c¢or, na~onal odgin, age, mlig~n, ma~al ~afus, medi~l <br />~ ¢ ~bEEy. In s~e i~an~s, ~weveo ~Int~nt to ~ain ~a~mmissions may ~ based upon the need <br />I ~ ~~ ~ ~ ~~mm~n. <br /> <br />~ ~ ~e appiimble ~x~: <br /> <br />M~e ~mle <br />18 a~ Under ~ 19 - 25 ~ 26 - 35 ~ 45 ~ 46 - 55 <br /> <br />~ -65 O66 and above <br /> <br />African American [] American Indian/Alaskan Native [] Asian/Pacific Islander <br />-lispanic [] Middle Eastern [~'l~ultiracial <br /> <br />/Vhite/European American <br /> <br />ability: [] Yes ~ If yes, please describe <br /> <br /> nguages other than English? ~(~s. [] No Which language(s)? <br /> <br />'PLICATION FOR APPOINTMENT TO <br /> <br />· e complete both sides of this application ~,c~:,o~ <br /> ReWse¢ October <br /> <br /> <br />