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RECEtVED <br />APPLICATION FOR AI OtNTMENT TO BY CITY MANAGERATTACHMENT C <br /> <br />Name ~ ,, , , <br /> First Middle Last <br /> <br />~Telephone ~~:~~~ ~ Day Telephone , <br /> <br /> Fax Number (E applicable) ~ E-Mail (If app,cable) <br /> HOW did you l~m of this va~ncy? ~ ~ Newspaper ~Word of mou{h UMail ~Web Page <br /> <br /> OPTIONAL iNFORMA T~N <br /> The ~uge~ C/~ ~ suppo~s d/vers~y ~d seeks to appo~ ~rsons who ~ep~esent ~e d~ers~y ~ ~e community. By <br /> prov~/ng the in~rmat~n below, you can he~ ~ c~y Counc~ ~o know ~f ~he aPPrehends matcb the d~ver~y ~ the <br /> community. A~i~ant~ am con~/~d w~hout regard ~o ~ce, sex, co/~, national or~in, a~, ml~ion, marital s~tus, medical <br /> condi~n~ or disabi/i~, tn some instances, however, appo~en~ ~o cedain b~rds/com~/~sions may be. ba~ed up~ ~he <br /> need to fi~ spec~ posi~on~ on the boa~/commission. <br /> <br /> Please check ~e appticab~ boxes: <br /> <br /> ~ Male ~ma~~ <br /> ~ ~8 and Hnd~r ~ ~0- 25 ~35 ~ 3~- 45 ~ 4~. 55 <br /> <br /> ['-1 African American [] American Indian/Alaskan Native [] Asian/Pacific Islander <br /> [~] I-~anic [] Middle Eastern [] Multiracial <br /> ~ White/European Ameri~an <br /> <br /> ~)isability: U Yes ~No If yes, please describe <br /> <br /> Fluent in languages other than English? [] Yes "(~ Which langcra~}e(s~. ~ <br /> <br /> Please ([h'nplete both sides of this application Application for/~ppe~tment tO C~iz:en Advisory B~s and Commissions- Page 1 <br /> 'PJevised September. 2001 - P:',CMO~CC',BCCAPP0109119.wpd <br /> <br /> <br />