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Application For Appointment To <br />Cabarrus County Advisory Boards and Commissions <br /> <br /> The Cabarrus County Board of Commissioners believes that all citizens should have the opportunity to participate in <br /> governmental decisions. One way of participating is by serving as a citizen member of one of the County's advisory boards. <br /> If you want to be considered for appointment to an advisory board, please complete the form below and mail it to the Board <br /> of County Commissioners, Post Omce Box 707, Concord, North Carolina 28026-0707. You r~i~[~k~[~s page and use <br /> as a self-mailer. <br /> <br /> Advisory Board / Commission Interested In: <br /> Ans'd. __ <br />-- 1 Cabarrus Health Authority Board -- <br /> <br />-- 3. <br /> <br />Name: Q. Ct2s3LL~ ¢. ~-o1'%{~0'~` ~ ~ Resident of Caba=s County ~ yes ~no <br />Address:.~ ~a~ ~~ - ~~k~ ~ l Circleyour township <br />~itl~/State/ZIP: ~ ~.~X,~ ~ ~[0~ ~;~r~Caba;ms Harrisburg <br /> e ephone: Home: ']O~ ~ ~ ~' ~.g Concord K~napolis <br /> Work: ~0q. 5~ ] ~1~ Georgeville Midl~d <br />N.C. Driver's License No.: Gold Hill Mount Pleasant <br />Occupation: ~V~¢ Cq ), ~ ~ ~~ <br /> <br />Age (optional): .5 [ Numar hours available per month lot this position: <br /> <br />Business and Civic Expeh&oe / Skills: '~ a~h~ ,'c~ ~ ' <br /> <br />New Gilead <br />Odell <br /> <br />Poplar Tent <br /> <br />Rimertown <br /> <br />Other County Boards / Committees / Commissions presently serving on: <br /> Board, Committee, Commission: <br /> Term Expiration Date: <br /> <br /> References <br />List three persons who are not related to you and who have definite knowledge of your qualifications and fitness for the position <br />for which you are applying. <br /> <br />Name Business / Occupation Address Telephone <br /> <br />I understand that this application will be kept on the active file for two years only and I hereby authorize Cabarrus County to <br />verify all information included in this application. <br /> <br />Date <br /> <br />ure of the Applicant <br /> <br />· .~.4. Cabarrus County Public Affairs Bulletin <br /> <br /> <br />