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(1) City of Tukwila <br />Tukwila City Hall <br />G2O08outhm*nterBlvd <br />Tukwila, WA 88188 <br />Phone: (206) 433-1800 Fax: (206) 433-1833 <br />Email: <br />VVebsite: <br />Application for Appointment <br />����[����Fl�����N0Y|��|���� <br />���^^�. ^��^� AND ����.�""���^.��.�^� <br />RECEIVED <br />Please complete the ENTIRE application form. Applicants may attach a cover letter and/or a resume <br />totaling no more than three pages. 12/26/ 2016 <br />Krn' <br />Last <br />Street <br />MAILING ADDRESS (if <br />HDk8EPHONE <br />Scott <br />First <br />7-Ukm/'|a <br />City <br />CELL8NOB|LEPHONE: <br />�� <br />�� <br />An <br />G��lF <br />Ek4PLOYE " E-MAIL: <br />Please check all that apply to you within the City of Tukwila limits: <br />[� <br />Resident [] BusineoaDvxner/F7epreeentative <br />[] <br />School District Representative [] High School Student <br />I wish to be considered for appointment to the following board or commission (check all that annM: <br />BOARDS & COMMITTEES: <br />[l Community Police Advisory <br />L] Human Services <br />El Library <br />[] Lodging Tax <br />E] Other/Special Committee: Public Safety Bond Financial Oversight Committee <br />HAVE YOU PREVIOUSLY SERVED ON ONE OF THESE BOARDS OR COMMISSIONS? El Yes 0 No <br />If "yes", please list: Parks CC)DlOO'ss'[>n Library Board of Advisors <br />AVAILABLE TQ ATTEND MEETINGS: 0Daytime 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 El No TERM EXPIRES: <br />O <br />Arts <br />LJ <br />Civil Service <br />0 <br />Equity &Diversity <br />LJ <br />Parke <br />[] <br />Planning <br />BOARDS & COMMITTEES: <br />[l Community Police Advisory <br />L] Human Services <br />El Library <br />[] Lodging Tax <br />E] Other/Special Committee: Public Safety Bond Financial Oversight Committee <br />HAVE YOU PREVIOUSLY SERVED ON ONE OF THESE BOARDS OR COMMISSIONS? El Yes 0 No <br />If "yes", please list: Parks CC)DlOO'ss'[>n Library Board of Advisors <br />AVAILABLE TQ ATTEND MEETINGS: 0Daytime 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 El No TERM EXPIRES: <br />