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SRLJC Committee Application
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Steps
1.
Step One
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2.
Step Two
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Step One
SRLJC COMMITTEE APPLICATION
Committee you are applying for:
*
-- Select One --
Racial Equity Committee
Today's Date
Today's Date
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Other Phone #
Email Address
EMPLOYMENT HISTORY
Present Employer
From / To
From / To Start Date
—
From / To End Date
Duties & Responsibilities
Previous Employer
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From / To Start Date
—
From / To End Date
Duties & Responsibilities
Previous Employer
From / To
From / To Start Date
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From / To End Date
Duties & Responsibilities
Continue
Step Two
EDUCATION
College or University
Type of Degree or Cert.?
Other Institution
Type of Degree or Cert.?
High School
Diploma? (Yes or No)
Do you have a pending criminal action against you? (If yes, please explain):
Please list your community-related activities and experience:
SERVICE
Please list current and past position(s) held on City / County Boards, Committees, and/or Commissions:
From / To
From / To Start Date
—
From / To End Date
Board or Commission
From / To
From / To Start Date
—
From / To End Date
Board or Commission
From / To
From / To Start Date
—
From / To End Date
Board or Commission
Why do you feel you would be a valuable member of the committee you are applying for?
How will you engage and inform other Spokane County citizens as their public representative on this committee?
UNDER THE PUBLIC DISCLOSURE ACT, ALL INFORMATION IN THIS APPLICATION IS SUBJECT TO DISCLOSURE UPON REQUEST EXCEPT THE FOLLOWING INFORMATION IS NOT SUBJECT TO DISCLOSURE: RESIDENTIAL ADDRESSES, RESIDENTIAL TELEPHONE NUMBER, PERSONAL WIRELESS TELEPHONE NUMBERS, AND PERSONAL ELECTRONIC MAIL ADDRESSES.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
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