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Application For Appointment To <br />Cabarrus County Advisory Boards and Commissions <br /> <br /> 'I~he 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 Office Box 707, Concord, North Carolina 28026-0707. You may detach this page and use <br />as a self-mailer. <br /> <br />Advisory Board / Commission Interested In: <br /> <br />Cabarrus Health Authority Board <br /> <br />City / State / ZIP: <br />Telephone: Home: <br /> Work: <br />N.C. Driver's License No.: <br />Occupation: <br />Business Address: <br /> <br /> Resident of Cabarrus County--r~'yes <br /> Circle your township <br />Central Cabarms Harrisburg <br />~ Kannapolis <br />Georgeville Midland <br />Gold Hill Mount Pleasant <br /> <br />[] no <br /> <br />New Gilead <br />Odell <br />Poplar Tent <br /> <br />Rimertown <br /> <br />Age (optional): ,~2: Number hours available per month for this position:.. <br />Educational Background: //~ Gf~zi:~t{cL¢~_,/e ~ ~ <.~o/~:g~,:, C~Z,'~t41' i. . C~/ <br /> <br />Business a~d Civic Experience / Skills: ~,,~U~-~ '.~vz.. X,/r..,.~/.~.o-~ ,.','* l.~5. ~ ~, ~.4~.,, <br /> <br />Other County Boards 1 Committees / Coz - mmissions presently se~mg ~n: :' O' ' <br /> Board, Committee, Commission: ~g <br /> Te~ Expiration Date: ~ <br /> <br /> References <br />List three persons who are not related to you and who have definite knowledge of your quail fications and fitness for thc position <br />for which you are applying. <br /> <br />Name Business / Occupation Address Telephone <br /> <br />understand that this application will be kept on the active file for two years only and I hereby authorize Cabarrus County to <br />verify ail information included in this application. <br /> <br /> Date { Signature of the Applican~ <br /> +.!. Cabarrus County Public Affairs Bulletin +':' 7 <br /> <br /> <br />