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8 <br /> APPLICATION FOR HAWAII COUNTY BOARDS AND COMMISSIONS <br /> Our goal is not only to comply with State and County regulations concerning board and commission composition but also <br /> to select members who contribute a diverse range of skills and life experiences. The answers to the following questions <br /> will help us achieve this objective. <br /> NAME DATE <br /> Last First Middle <br /> RESIDENCE ADDRESS <br /> City State Zip <br /> MAILING ADDRESS <br /> City State Zip <br /> PHONE <br /> Home Business Cell Fax <br /> E-MAIL <br /> U.S. CITIZEN ❑ Yes ❑ No HAWAII COUNTY VOTER ❑ Yes ❑ No COUNCIL DISTRICT <br /> (Call 961-8277 if not sure) <br /> DATE OF *Last 4 SOCIAL LENGTH OF RESIDENCE <br /> BIRTH SECURITY NO. IN HAWAII <br /> MARRIED ❑Yes ❑ No NAME OF SPOUSE <br /> EDUCATION <br /> EMPLOYMENT RECORD (Past 10 years) <br /> From (Year) TO (Year) EMPLOYER OCCUPATION <br /> Are you currently serving on any federal, state, or county board or commission? ❑ Yes ❑ No <br /> If yes, name the entity and date your term ends: <br /> List by preference the board or commission you wish to serve on: <br /> 1. 3. <br /> 2. 4. <br /> Briefly explain your interest in being a member of a particular board or commission. <br />