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O City of Tukwila <br />01 <br />10 <br />Tukwila City Hall <br />6200 Southcenter Blvd <br />Tukwila, WA 98188 <br />Phone: (206) 433-1800 Fax: (206) 433-1833 <br />RECEIVED <br />Email: BoardsCommsa-tukwilawa.gov <br />Website: www.tukwilawa.gov <br />Application for Appointment <br />BOARDS AND COMMISSIONS <br />Please complete the ENTIRE application form. Applicants may attach a cover letter and/or a resume <br />totaling no more than three pages. 03/10/2017 <br />DATE: <br />NAME:-Reiswig Andy <br />Last First M.I. <br />ADDRESS. Seattle 98102 <br />Street City Zip <br />MAILING ADDRESS (if different): <br />HOME PHONE: CELUMOBILE PHONE. <br />. BECU <br />EMPLOYEIR. , E-MAIL: <br />Please check all that apply to you within the City of Tukwila limits: <br />❑ Resident 121 Business Owner/Representative <br />❑ School District Representative ❑ High School Student <br />I wish to be considered for appointment to the following board or commission (check all that apply): <br />COMMISSIONS: <br />❑ <br />Arts <br />❑ <br />Civil Service <br />❑ <br />Equity & Diversity <br />❑ <br />Parks <br />❑ <br />Planning <br />BOARDS & COMMITTEES: <br />❑ Community Police Advisory <br />0 Human Services <br />❑ Library <br />❑ Lodging Tax <br />El Other/Special Committee: Bond Financial Oversight Committee <br />HAVE YOU PREVIOUSLY SERVED ON ONE OF THESE BOARDS OR COMMISSIONS? ❑ Yes 21 No <br />If "yes", please list: <br />AVAILABLE TO ATTEND MEETINGS: El Daytime El Evenings <br />Please contact me regarding other City of Tukwila volunteer opportunities (check box): ❑ <br />FOR CITY USE ONLY: <br />INTERVIEW DATE: APPOINTED: ❑ Yes ❑ No TERM EXPIRES: <br />23 <br />