April 16, 2012 - Cabarrus County

Office Use OnlyDATE RECEIVED:Application for Appointment toCabarrus County Advisory Boards and CommitteesThe Cabarrus County Board of Commissioners believes that all citizens should have the opportunity to participate ingovernmental decisions. One way of participating is by serving as a citizen member of one of the County’s variousadvisory boards. If you wish to be considered for appointment to an advisory board, please complete the informationbelow and return it to the CLERK TO THE BOARD OF COMMISSIONERS, P. O. BOX 707, CONCORD, NC 28026-0707, Fax (704) 920-2820. For more information about the various boards, you may contact the Clerk at (704) 920-2109.Advisory Board(s) / Committee(s) Interested In: (Please list in order of preference)1.________________________________________________________________________________________________2.________________________________________________________________________________________________3._______________________________________________________________________________________________❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃ ❃Name: ____________________________________________________________________________________________Home Address: _____________________________________________________________________________________Mailing Address (if different):___________________________________________________________________________City / State / ZIP: ___________________________________________________________________________________Resident of Cabarrus County: ____ Yes____ NoTelephone: Home: ___________________________________ Work: _______________________________________Cell: ____________________________________ Fax: _________________________________________Email Address: ____________________________________________________________________________________Occupation:________________________________________________________________________________________Business Address: __________________________________________________________________________________City / State / Zip: ___________________________________________________________________________________Do You Have a N. C. Driver’s License? _____ Yes _____ NoAge (optional): _______________________Number hours available per month for this position: _______________________________________________________Best time of day/or days available:______________________________________________________________________- over -Attachment number 4I-3Page 253