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06/23/04 WED 06:40 FAX 541 686 3570// S W P I C <br />'" .~y~X.~ ~3~~ ATTACHMENT C <br /> RECEIVED <br /> APPLICATION FOR APPOINTMENT TO BY CITY MANAGER <br /> CITIZEN ADviSORY BOARDS AND COMMISSIONS P 9nn <br /> Please Pdnt or Type. ' <br /> <br /> Board or Commlssion Lane Workforce Partnership - Board of Directors <br /> <br /> N am e Cato lyre W. Kalish <br /> First Middle Le~t <br /> Home Address 2992 Edgewatsr Drive Eugene 97401 <br /> Street City Zip <br /> Do you reside within th~ta? ~]Yea [] Nc If yes, how long? ,. 28 <br /> <br /> Day Telephone <br /> Occupation I-Iumazz Resources <br /> Place of Employment Comcast <br /> BuslnessAddress 2897 Chad Drive Eugeme 97408 <br /> <br /> Fax Number (if applicable) 631-366! <br /> E-Mail (If applicable) CarolT'n-./..~a].'~ sh@cab'l e, comcas I:. col <br /> How did you learn of this vacancy? r-~Newspaper [~Word of mouth ~]Mail I']web Page <br /> Oth r Source Iavltation <br /> <br /> OPTIONAL INFORMATiON <br /> The Eugene City Council supports diversity and seeks to appoint persons who represent ~he diversity of the ~ommunity. By <br /> providing the information below, you oen help the City Council ~o 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 statue, medical <br /> condition, or disability. In soma instances, however, appointment to certain boards/commissions may be based upon the <br /> need to fill specific positions On the board/commission. <br /> <br /> Pi asa check the applicable boxes: <br /> <br /> [] Male ~ Female <br /> <br /> [] 18 and Under [] 19 - 25 [] 26 - 35 i'"I 36 - 45 [] 46.55 <br /> D 56 - 65 [] 66 and above <br /> <br /> [] African American [~ American Indian/Alaskan Native [] Asian/Pacific Islander <br /> [] Hispanic [] Middle Eastern [] Multiracial <br /> [~ White/European American <br /> <br /> Disability: [] Yes [] No If yes, please describe <br /> <br /> Fluent in languages other than Engllsh? [] Yes ~ No Which language(s)? <br /> <br />Please COmplete both sides of ~ie application <br /> Al~lleat~on for ~l~lntmant/= Clazan .~vrcmy ~ and (3ornmt~ona- <br /> Re'/re~l 8epic.q-/mr, 2001 · R~CM0~.BCC~CCAPfa010911§.wpd <br /> <br /> <br />