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055 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDSHCOMMISSIONS <br />If you are a Lee County citizen interested in serving as a member of one of the County's Advisory Boards, <br />please complete the form below and mail to Clerk to the Board, Lee County Government Center, PO Box 1968, <br />Sanford, NC, 27331-1968 or fax to 718-4631. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <br />_ Jury Commission <br />_ Library Board of Trustees <br />_ Mid-Carolina Workforce Development Board <br />_ Parks & Recreation Commission <br />_ Planning Board (Lee County) <br />_ Planning Board (Sanford) <br />_ Rest Home-Nursing Home Advisory Board <br />_ Senior Services Advisory Board <br />_ Social Services Board <br />_ Transportation Advisory Board <br />_ Juvenile Crime Prevention Council <br />_ Criminal Justice Partnership Advisory Board <br />Industrial Facilities & Pollution Control Financing Auth. <br />_ Sanford-Lee County Airport Authority <br />Agriculture Advisory Board <br />_ Americans with Disabilities Act (ADA) <br />_ Board of Adjustments (Lee County) <br />_ Board of Adjustments (Sanford) <br />_ Board of Equalization & Review <br />_ Cemetery Board of Trustees <br />_ CCCC Board of Trustees <br />Economic Development Corp. <br />Fire Advisory Board <br />_ Environmental Affairs Board <br />Board of Health <br />NAME: UQV I <br />MAILING ADDRESS: <br />• <br />HOME PHONE: 776 332 WORKPHONE: 91S-,QN E-MAIL a /cam r (~`I~rNC.Cbt <br />YEARS LIVING IN <br />LEE COUNTY: 9 1~ DISTRICT YOU LIVE IN: 6V QPiq W 0n <br />MALE: 9FEMALE: _ WHITE: BLACK: HISPANIC: _ NATIVE AMERICAN OTHER <br />/(In ormation for the purpose of assuring a cross section of the community) <br />EMPLOYER: Cv U S L L C <br />OCCUPATION ~1~~t1y011~^4~tCGtQI rj ~Gt Vv1~f[ldt~PV <br />OTHER MUNICIPAL OR COUNTY BOARDS/COMMITTEES ON WHICH YOU ARE SERVING: <br />(Generally, the Board of Commissioners desires to broaden participation on Boards/Commissions for as much citizen involvement <br />as possible; therefore per Board policy, appointees can serve on no more the two (2) Boards/Commissions at a time. <br />PLEASE LIST THREE (3) LOOCCAL <br />1. (L1 ru 1 RZ L ,Ja <br />2. <br />REFERENCES AND PHONE NUMBERS: <br />'ttJ-I"! lJ~ <br />3q9 <br />3. "c&A `-'r- t l r l w <br />SIGNATURE: DATE: ~g 7~ <br />JUN 2 2 20i¢~~ <br />