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06/23/04 WED 06:39 FAX 541 686 3570 S W P I C <br /> z3 :CEIVED ATTACHMENT B <br /> <br /> 8Y CITY MANAGER <br /> APPLICATION FOR APPOINTMENT TO <br /> CITIZEN ADVISORY BOARDS AND COMMISSIONS <br /> Please Print or Type. <br /> <br /> Board or Commission Lane Workforce Partnership - Board' of-Directors <br /> <br /> N am e l{onald Glenn Thomas <br /> First Middle Last <br /> Home Address 575 River Hills Drive Springfield 97477 <br /> ~treet City Zip <br /> Do you reside within the City limits?~__~ [] Yes [] No if yes, how long? ~ . <br /> CIty C°uncil Ward ~~ / Neighborhood Organizati%~/ ,, <br /> Home Telephone 735-9422 3/+5-7999 - <br /> Day Telephone <br /> Occupation Te].ecommunicatlons Sales <br /> Place of Employment Oregon Telecom <br /> BuslnessAddmsa 300 Country CLub Road, Suite 100 Eugene 97401 <br /> <br /> Fax Number (~applicable) 345-1811 <br /> E-Mall (if applicable) rthomas@oregontelecom, com <br /> How did you I am of this vacancy? [] Newspaper [] Word of mouth [] Mall [] Web Page <br /> Other Source <br /> <br /> OP TIONA L INFORMATION <br /> The Eugen City Counct7 supports diversity and seeks to appoint persons who represent the diversity of the community. By <br /> providing the information below, you can help the Cfty Counc# to know if the appointments match the diversity of the <br /> community. Applicants are o'onsidered without regard to mca, sex, color, na#onal origin, age, religion, marital status, medical <br /> condigon, or disabiffty. In some Instances, however, appointment to certain boards/commissions may be based upon the <br /> need to fill specific positions on the boercl/commlaa$on. <br /> <br />Please check the applicable boxes: <br /> <br /> ~ Male ['3 Female <br /> <br />I-I18 and Under I-!19- 25 1'-126-35 !-136-45 t~146- 55 <br />r'156 -65 1-166 and above <br /> <br />I-1 African American [] American Indian/Alaskan Native [] Asian/Pacific Islander <br />I~ Hispanic [] Middle Eastern [] Multiracial <br />I~ W hitelEuropean American <br /> <br />Disability: I-I. Yes [] No If yes, please describe <br /> <br />Fluent in languages other than English? [] Yes [] No Which language(s)? <br /> <br /> <br />