Refugee and Immigrant Affairs

Refugee and Immigrant Affairs

Additional Languages

Spanish | Russian | Vietnamese | Khmer | More Options

Optional - Print Application

Download and Print the Application: https://www.piercecountywa.gov/3035/Application or continue filling out the online application below.

Name

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

Select

Address

Residential Street Address NOT a PO Box

City, State, Zip

What is the ownership status of your place of residence?

Select

Home Phone

Cell Phone

Work Phone

Email Address

Date of Birth

Pierce County Council District

Select

State Legislative Voting District Number

Not sure which district you live in? Use the Info By Address https://matterhornwab.co.pierce.wa.us/infobyaddress/

Do you have lived experience as a refugee or immigrant?*

Select

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?

Select

Education

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

Professional/Community Activities

Describe your interest in serving.

Describe your qualifications for this position

File Attachments

Drag and drop files here or

Are you at least 18 years old?*

Select

Please describe any accommodations (ie. Translator, technology, equipment, etc) you would need to serve on this board/commission?*

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

Select

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*

Select

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

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