Tacoma Narrows Airport Advisory Commission Application

Name

Which of the following locations is most relevant to this appointment?

Address

Residential Street Address NOT a PO Box

City, State, Zip

What is the ownership status of your place of residence?

Home Phone

Cell Phone

Work Phone

Email Address

Date of Birth

mm/dd/yyyy

Pierce County Council District

Occupation and Employer

(If retired, please indicate “Retired” with your former employer and occupation)

What is the highest degree or level of school you have completed?

Education

(Name of high school, college/university, degree)

Professional/Community Activities

Describe your interest in serving.

Describe your qualifications for this position

Drop your files here

Are you at least 18 years old?

Can you perform the essential functions and meet the attendance requirements for serving on this board/commission with or without an accommodation?

Are you, your spouse, or a member of your immediate family an employee of Pierce County? Yes / No If yes please identify:

Employee of Pierce County

If you answered yes to the question above please identify in the space below:

Are you currently serving on any other Pierce County Boards or Commissions? Yes / No

Serving on any other County Board or Commission

If you answered yes to the question above, please identify in the space below:

Personal Reference #1 Name

Personal Reference #1 Occupation

Personal Reference #1 Address

Personal Reference #1 Phone

Personal Reference #2 Name

Personal Reference #2 Occupation

Personal Reference #2 Address

Personal Reference #2 Phone

Personal Reference #3 Name

Personal Reference #3 Occupation

Personal Reference #3 Address

Personal Reference #3 Phone

Digital Signature

Send me a copy of my responses