Application for Committees, Boards, Commission Application Form for Committees/Boards/Commissions
Spokane Return completed form to City Clerk:
_,Valley Spokane Valley City Hall
10210 East Sprague Avenue Spokane Valley,WA 99206
Phone: 509-720-5102 cbainbridge@spokanevalley.org
[Note: To meet an application deadline, applications may be faxed or e-mailed. However, the Clerk's office will need an original, signed
application prior to appointment. One application per position please. DO NOT SUBMIT AN APPLICATION UNLESS THERE IS AN
OPENING.OPENINGS ARE POSTED ON THE CITY'S WEBPAGE AND ADVERTISED IN THE LOCAL NEWSPAPERS.
Call the City Clerk if you have questions.]
I AM INTERESTED IN SERVING ON THE FOLLOWING COMMITTEE: [Check one box;note requirements]
[ ]Planning Commission—Must be a Spokane Valley resident.(See chapter 18.10 SVMC)
Terms are for three years.Applicants are selected without respect to political affiliations,and serve without compensation.
[ ] Lodging Tax Advisory Committee(LTAC)-Need not be a Spokane Valley resident. (See chapter 3.20 SVMC)
Terms are for one or two years.Committee consists of five members:
One Councilmember:appointed by the Mayor,confirmed by the Council.
Two who represent a business required to collect the tax(hotels,motels,etc.).
Two involved in funded activities(such as a non-profit organization to increase tourism).
Identify the business or organization you represent
[ ] Spokane County Housing and Community Development Advisory Committee(HCDAC)
HCDAC includes two Spokane Valley residents;terms not to exceed three years.
Spokane Valley appointment pending final approval by Spokane County Board of Commissioners.
Spokane County Application and Supplemental Application also required.
[ ] Spokane County Human Rights Task Force —Terms are for four years.Must be a resident of Spokane Valley.
The Board currently meets 2nd Tuesday of each month,3:30 to 5:00 at Catholic Charities, 12 E 5th Spokane.
[ ] Spokane Housing Authority(SHA)—regional committee,five members.Terms are five years.
One individual directly assisted by the Authority,jointly appointed by Spokane Mayor,Spokane Valley Mayor,and
Chair of Board of County Commissioners.
Two individuals who work or reside within Spokane City limits.
One individual who works or resides in unincorporated Spokane County.
One individual who works or resides within Spokane Valley City limits.
Check with the City Clerk concerning a vacancy on this committee.
[ ] Tourism Promotion Area,Hotel Advisory Committee(aka Hotel/Motel Association)—Terms are for three years.
Spokane Valley appoints two members,and one ex-officio(a member of Council).
All nominees must be operators or employees of lodging business within Spokane County.
[ ] Other:
Name(please print):
Complete residence address:
Street City Zip Code
Complete mailing address(if different from above address):
Length of time residing at current address:
U.S. Citizen? [ ]yes [ ]no WA State registered voter? [ ]yes [ ]no
What is your preferred way for us to contact you: [Note:If you have an unlisted phone number, or do not wish your e-
mail address made public, do not include that information. Once this document is submitted to the City, it becomes subject to
public disclosure]
[ ] Home Phone: [ ] Work phone:
[ ] Cell Phone: [ ] Other message phone:
[ ] E-mail address: (please print clearly):
[ ] Regular mail to residence or mailing address shown above
EMPLOYMENT: (Please start with most recent)
1. [ ] present [ ] previous
Name of employer:
Address: Phone:
Position held: Dates of employment:
2. [ ] present [ ] previous
Name of employer:
Address: Phone:
Position held: Dates of employment:
3. [ ] present [ ] previous
Name of employer:
Address: Phone:
Position held: Dates of employment:
4. [ ] present [ ] previous
Name of employer:
Address: Phone:
Position held: Dates of employment:
EDUCATION:
Name of high school Address:
Diploma or GED: [ ] yes [ ] no
Trade school/college/university:
Name of School Address:
Diploma: [ ] yes [ ] no Degree or certification earned:
Trade school/college/university:
Name of School Address:
Diploma: [ ] yes [ ] no Degree or certification earned:
Other relevant certifications/licenses:
VOLUNTEER EXPERIENCE: Name of social,fraternal,organizations,etc.
1. [ ] current [ ] previous
2. [ ] current [ ] previous
3. [ ] current [ ] previous
4. [ ] current [ ] previous
PROFESSIONAL ORGANIZATIONS. Local,state,or national government boards,committees,or commissions
on which you serve or have served.
1. [ ] current [ ] previous
2. [ ] current [ ] previous
3. [ ] current [ ] previous
4. [ ] current [ ] previous
5. [ ] current [ ] previous
REASONS for applying for this committee, commission, board:
By signing this application, I certify under penalty of perjury of the laws of the State of Washington that all
information is true and correct to the best of my knowledge and belief. I further state that my appointment would not
represent a conflict of interest or an appearance of a conflict of interest with the duties of this position. I understand
this application is subject to disclosure pursuant to chapter 42.56 RCW.
Signature Date Signed