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vol, I u <br />APPLICATION FOR HAWAII COUNTY BOARDS AND COMMISSIONS <br />Our goal, in addition to meeting State and County regulations regarding the composition of a particular board or <br />commission, is to select members who bring a variety of skills and life experiences to these agencies. The answers to the <br />following questions can assist us in these efforts. <br />NAME BUR]AN CHAL-iNTORN N DATE NOU� ( _ 1017 <br />Last First Middle <br />RESIDENCE ADDRESS J} J} - 4 6 b W A t K A yt u L p H 'P a R LL I)- () N 1 6 17 7% <br />City State Zip <br />MAILING ADDRESS - 0� 3 b. N L) k is Id 1 g b'7 A 7 <br />City State Zip <br />PHONE 0t6) x'7-75- 10164 J+3 -4 -If -7Ci -- <br />Home Business Cell Fax <br />E-MAIL C lea. No -i» bLA I l A wl 6G 14 loo c' 10 -1/0 <br />U S CITIZEN Z Yes ❑ No HAWAII COUNTY VOTER D�Yes ❑ No COUNCIL DISTRICT <br />(Call 961-8277 if not sure) <br />DATE OF *SOCIALLENGTH OF RESIDENCE <br />BIRTH An 1)- a,4 r I Rif % SECURITY NO 5773-C6&" bb IN HAWAII O <br />MARRIED C3 Yes ❑ No NAME OF SPOUSE F R C -"b I C- H �S g> u R 1 g N <br />EDUCATION <br />01 8 6l V1 , 3 A l c V%-KJL s \A Irl Vv" UK" v a y 5 i <br />C ctco o H <br />tM-►11��IsJ►L'd , tA �M <br />EMPLOYMENT RECORD (Past ten years) <br />FROM (Year) TO (Year) EMPLOYER <br />OCCUPATION <br />I Cl 01 17 — '�- , , r 4 1 ' t Y e �6 <br />Are you currently serving on any federal, state or county board or commission? ❑ Yes LK 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 h R. (Xya,u COU -h+4 &W -r i i H -U- RY) AQ <br />2. " 4. <br />Briefly explain your interest in being a member of a particular board or commission. e <br />x. 1A¢- W t-O�i� S zv rn a-kl�-ri �V`eQ4Grnti+� c t� Y" <br />�Yo � V Y "J-&,! a. V o <br />A 01 <br />Are you currently an official and/or card carrying member of any political party? ❑Yes PI'No <br />If"yes," what political party? <br />