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Home My WebLink About2017-12-05 Ltr to Kimo Alameda re: Committee on AgingHarry Kim Mavor Wil Okabe Managing Director Barbara J. Kossow Deputy Managing Director &UU fir of (offirr of #4e ffinva ~ 25 Aupuni Street, Suite 2603 • Hilo, Hawai'i 96720 • (808) 961-8211 • Fax (808) 961-6553 KONA: 74-5044 Ane Keohokalole Hwy., Bldg C • Kailua-Kona, Hawai'i 96740 (808)323-4444 • Fax(808)323-4440 December 5, 2017 Mr. Kimo Alameda County Executive on Aging Office of Aging 1055 Kino'ole Street, Suite 101 Hilo, HI 96720 Dear Mr. Alameda, RE: Committee on Aging Pursuant to the Hawaii County Charter, Article IV, Section 4-4, Advisory Commission, I am pleased to appoint the following individual to the Mayor's Committee on Aging: Charlintorn N Burian Her membership shall be co -terminus with my current term in office, which will end December 1, 2020. Sincerely, Harry Kim MAYOR c: Charlintorn N Burian J Yoshimoto, Corporation Counsel Luana Ancheta-Kauwe, Office of Aging County of Hawaii is an Equal Opportunity Provider and Employer. vol, I u APPLICATION FOR HAWAII COUNTY BOARDS AND COMMISSIONS Our goal, in addition to meeting State and County regulations regarding the composition of a particular board or commission, is to select members who bring a variety of skills and life experiences to these agencies. The answers to the following questions can assist us in these efforts. NAME BUR]AN CHAL-iNTORN N DATE NOU� ( _ 1017 Last First Middle 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% City State Zip MAILING ADDRESS - 0� 3 b. N L) k is Id 1 g b'7 A 7 City State Zip PHONE 0t6) x'7-75- 10164 J+3 -4 -If -7Ci -- Home Business Cell Fax E-MAIL C lea. No -i» bLA I l A wl 6G 14 loo c' 10 -1/0 U S CITIZEN Z Yes ❑ No HAWAII COUNTY VOTER D�Yes ❑ No COUNCIL DISTRICT (Call 961-8277 if not sure) DATE OF *SOCIALLENGTH OF RESIDENCE BIRTH An 1)- a,4 r I Rif % SECURITY NO 5773-C6&" bb IN HAWAII O MARRIED C3 Yes ❑ No NAME OF SPOUSE F R C -"b I C- H �S g> u R 1 g N EDUCATION 01 8 6l V1 , 3 A l c V%-KJL s \A Irl Vv" UK" v a y 5 i C ctco o H tM-►11��IsJ►L'd , tA �M EMPLOYMENT RECORD (Past ten years) FROM (Year) TO (Year) EMPLOYER OCCUPATION I Cl 01 17 — '�- , , r 4 1 ' t Y e �6 Are you currently serving on any federal, state or county board or commission? ❑ Yes LK No If yes, name the entity and date your term ends: List by preference the board or commission you wish to serve on: 1 h R. (Xya,u COU -h+4 &W -r i i H -U- RY) AQ 2. " 4. Briefly explain your interest in being a member of a particular board or commission. e x. 1A¢- W t-O�i� S zv rn a-kl�-ri �V`eQ4Grnti+� c t� Y" �Yo � V Y "J-&,! a. V o A 01 Are you currently an official and/or card carrying member of any political party? ❑Yes PI'No If"yes," what political party? COMtrIUNITY SERVICE (Organizations; offices held; indicate past or present): R� �v►a o � ��013 aols� it e s e-Inj CV 4 'T 1z��3. N G\ A 1� t t� t� i Q l r yw 2.DS�1C� a01d o �svc� lvl 12 MILITARY SERVICE RECORD Applicable laws require the pre -disclosure of any existing or potential conflicts of interest. Should you have any such conflicts of interests which may be questioned, please describe them below- I)u� —� W1 uic 1JVC10 a[!u require ine Tiling or a rrnancial Disclosure Statement. If required, would you comply? N Yes ❑ No Have you ever been convicted of a violation of law? ❑ Yes D'No If yes, explain. NOTE. A conviction record will not be deemed a basis of denial for consideration, unless the offense is related to the board or commission for which you have applied. FtKSUNAL KEFERENGES M's �011�)YI�(,YttCJ/1vL �1 Hon I hereby acknowledge and attest that the foregoing information providecrby me is true and correct to the best of my information and belief I hereby waive any and all right to privacy and authorize the Office of the Mayor and its employees, agents and assigns to investigate and obtain information concerning my fitness and/or ability to serve as an appointee of the County of Hawaii. I herein waive any and all claims against the County of Hawaii, its officers, employees, agents and assigns, and any person and/or entity furnishing information, for liability and/or damages as a result of the dissemination and obtaining of this information. SIGNED BY THE INFORMATION CONTAINED IN THIS APPLICATION IS CONFIDENTIAL AND IS SOLELY INTENDED FOR USE BY THE MAYOR'S OFFICE IN MATTERS PERTAINING TO BOARDS AND COMMISSIONS. IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE OFFICE OF INFORMATION AT 961-8223. PLEASE RETURN COMPLETED FORM TO - OFFICE OF THE MAYOR, COUNTY OF HAWAII 25 AUPUNI STREET, #2602 HILO, HI 96720 'This information is requested for the purpose of conducting a criminal history check only