Equal Employment Advisory Committee Application Form

Personal Information

Last Name

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First Name

*

Email

*

Home Address

*

City/Town

*

Zip Code

*

Home Phone

*

Are You Over 18 Years of Age?

Yes

No

*

Employment Information

Employer's Name

Employer's Address

Employer's Phone

Present Occupation

Additional Questions (attach additional pages if necessary)

Summary of Qualifications for Representing the Above Category:

Summary of Qualifications for the Appointment:

Reasons for Applying:

Please describe what diversity you would bring to the committee:

Please describe your experience in working and effectively communicating with members of all races and people from a wide variety of ethnic and socio-economic backgrounds:

List any organizations of which you are an officer or an employee which are funded by or provide services to county government:

Acknowledgement

Signature:

Date:

*

Check to confirm that all information I have provided in my application is true, complete, and correct. I also confirm that I have not omitted any information called for by this application. I understand any information I provide (or fail to provide) that is found to be false, incomplete, or contains a misrepresentation in any respect will be sufficient cause to cancel further consideration of this application.

Equal Employment Advisory Committee Application Form

APPLICATION FOR APPOINTMENT TO THE EQUAL EMPLOYMENT ADVISORY COMMITTEE