Accessible Communities Advisory Committee Application

Accessible Communities Advisory Committee Application

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

What is the street address of that location?

What is the city, state and zip code of that location?

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

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

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

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

Select

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

Select

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

Select

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 (Type out your name)*

Send me a copy of my responses

Privacy Notice|Report Abuse