Washington County OR: Board Application

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Profile

First Name *
Middle Initial
Last Name *

Home Address *
Suite or Apt
City *
State *
Postal Code *

Email Address *

Alternate Email Address

Primary Phone * Primary Phone
Alternate Phone Alternate Phone

Employer
Job Title
Occupation

Are you employed in Washington County? * Yes No

If you live in Washington County, in what district do you reside in? *

District look-up here

What days and times are you available to meet? *

Please list the Washington County Boards that you are currently serving on, or have previously served on (include the dates of your term).

Interests & Experiences

Which Boards would you like to apply for? *

This board has a vacancy

If you selected multiple Boards, which is your preferred choice?

How did you hear about the Board/s you are applying for? *

Why are you interested in serving on the Board/s you are applying for? *

Are you interested in other volunteer opportunities? Yes No

If you are interested in other opportunities, may we contact you? Yes No

What education, work experience, volunteer experience or life experience do you bring? *

Describe your understanding of the concerns and issues facing the Board/s you wish to serve on. *

List any potential conflict of interest between your public and private service that might result from your appointment to a Board/s you are applying for. *

Washington County is committed to racial equity and addressing inequities in our programs and services. We lead with race with the recognition that the creation and perpetuation of racial inequities have been built into American culture and our government, and that racial inequities across all indicators for success are deep and pervasive. What experiences, perspectives and values would you bring to support Washington County's equity work through your appointment to this committee/board? *

Upload a Resume
Accepted file types: RTF, DOC, DOCX, PDF, TXT, JPG, JPEG, GIF, PNG

References

Full name of Reference #1

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement *

By submitting this form, I am affirming that all the information is true to the best of my knowledge and that I understand that any misstatement of fact or misrepresentation of credential may result in this application being disqualified from further consideration or, subsequent to my appointment to a board/committee/commission, may result in dismissal. Also, information I provide on this application may become part of the public record.

I Agree *

Demographics

Washington County is committed to equity, diversity, and inclusion. Completing the demographic information on the application is voluntary, but we encourage you to provide that information. The County uses this information to help ensure that advisory body appointments represent a broad cross-section of community. State and federal law prohibit use of this information to discriminate against you; however we will consider as elements of our appointment criteria, the degree to which the candidate will contribute to one or more of the following: (a)Diversity of viewpoint; (b)Demographic variety reflecting the racial and gender population of the state or the region of appointment; and (c)Remediation of existing disparities between the number of qualified applicants of one race or gender and the number of members of such groups serving on the board, commission, committee or council.

Sexual Orientation
Gender
Date of Birth

Race/Ethnicity

If you selected "Two or more, or other", please describe.

Year of birth

Please Agree with the Following Statement *

"As an appointed member of a Washington County board or commission, I am aware that I am considered a public official and subject to Oregon Ethics law limitations on acceptance of gifts, food/drink, travel, and entertainment worth more than $50 per calendar year from any source with an administrative or policy interest in your board or commission. If I am appointed to the Planning Commission, I will also be required to complete an annual form with the Oregon Ethics Commission during the term of service. Please refer to the Oregon Ethics Commission website for more information about ethics requirements for public officials: http://cms.oregon.gov/ogec/pages/index.aspx."

I Agree *

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Washington County, OR Boards & Commissions

Application Form

Profile

Interests & Experiences

References

Acknowledgment

Demographics