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0 City of Tukwila <br />Tukwila City Hall <br />6200 Southcenter Blvd <br />Tukwila, WA 98188 <br />Phone: (206) 433-1800 Fax: (206) 433-1833 <br />Email: Board sComrns(cDtu kwilawa . q ov <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. DATE: 01/20/2017 <br />NAME: Werle <br />Last <br />ADDRESS <br />Street <br />Wayne C <br />First M1 <br />Tukwila 981684720 <br />City Zip <br />MAILING ADDRESS (if different): <br />CELUMOBILE PHONE: NSA <br />HOME PHON . <br />, Retired <br />EMPLOYER <br />E-MAI <br />Please check all that apply to you within the City of Tukwila limits: <br />0 Resident <br />❑ Business Owner/Representative <br />❑ School District Representative ❑ High School Student <br />I wish to be considered for appointment to the following board or commission (cheek all that apply): <br />COMMISSIONS: <br />BOARDS & COMMITTEES: <br />❑ Arts <br />❑ Community Police Advisory <br />❑ Civil Service <br />❑ Human Services <br />❑ Equity & Diversity <br />❑ Library <br />❑ Parks <br />❑ Lodging Tax <br />❑ Planning <br />171 Other/Special Committee: Public Safety Bond Financial Oversight Committee <br />HAVE YOU PREVIOUSLY SERVED ON ONE OF THESE BOARDS OR COMMISSIONS? ❑ Yes El No <br />If "yes", please 1i <br />AVAILABLE TO ATTEND MEETINGS: 121 Daytime 0 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 />25 <br />