April 16, 2012 - Cabarrus County

Educational Background: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Business and Civic Experience: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Areas of Interest / Skills: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other County Boards / Committees / Commissions presently serving on: ________________________________________________________________________________________________________Term Expiration Date: ______________Have you ever been charged with and / or convicted of a criminal offense? ________ If so, please explain________________________________________________________________________________________________________________________________________________________________________________________________________________ReferencesList three persons who are not related to you and who have definite knowledge of your qualifications and fitness for theposition for which you are applying.Name Business / Occupation Address TelephoneI understand that this application will be kept on active file for two years and I hereby authorize Cabarrus County to verifyall information included in this application. I further understand this application is subject to the N. C. Public RecordsLaw (NCGS 132-1) and may be released upon request. Meetings of the appointed boards and committees are subject tothe N. C. Open Meetings Law (NCGS 143-318.10)._________________________________Date__________________________________________________________Signature of the ApplicantBOC 001 (Revised 07/06)I-3Attachment number 4Page 254