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015 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDS / /COMMISSIONS <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 />Q 13:0ARDSIAND COMMISSIONS <br />Sanford -Lee County Airport Authority _ Jury Commission <br />_ Agriculture Advisory Board _ Library Board of Trustees <br />_ Americans with Disabilities Act (ADA) _ Mid- Carolina Workforce Development Board <br />_ Board of Adjustments (Lee County) _ Parks & Recreation Commission <br />_ Board of Adjustments (Sanford) _ Planning Board (Lee County) <br />_ Board of Equalization & Review _ Planning Board (Sanford) <br />_ Cemetery Board of Trustees _ Rest Home - Nursing Home Advisory Board <br />_ CCCC Board of Trustees _ Senior Services Advisory Board <br />_ Economic Development Corp. _ Social Services Board <br />_ Fire Advisory Board _ Transportation Advisory Board <br />_ Environmental Affairs Board _ Juvenile Crime Prevention Council <br />_(/Board of Health _ Criminal Justice Partnership Advisory Board <br />_ Industrial Facilities & Pollution Control Financing Auth. <br />MAILING ADDRESS: ��(j� �ni.vi�`('v�_ \C�PI�I� , �/�'fU{`0 ✓�lIIL�I3 <br />• HOME PHONE: II�J'Z�I'07.7 - U WORK PHONE: �Jr ��J� E -MAIL i <br />YEARS LIVING IN <br />LEE COUNTY: DISTRICT YOU LIVE IN: <br />MALE: _ FEMALE: ✓WHITE: _ BLACK: HISPANIC: NATIVE AMERICAN _ OTHER , <br />(Information for the purpose of assuring a cross section of the community) <br />1� II � �1 JJ <br />EMPLOYER: ✓�Lif KS �L� C— 1 �'tY1��ifF rJ �..ek1 Fl '!�- t��u <br />i <br />OCCUPATION: <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) BoardsJCommissions at a time <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. elo <br />3. ;� � /� /S- 770 -G <br />SIGNATURE: / `✓VP �.- <br />DATE: <br />JAN 2 7 20 <br />