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2. SNOHOMISH COUNTY BOARDS & COMMISSIONS APPLICATION FORM
4. NOMINEE: Please fill in this section
6. Name of Board/Commission:
   -- Select One --ADA Citizen Advisory CommitteeAgricultural Advisory BoardAirport CommissionAnimal Advisory BoardArts CommissionBoard of EqualizationBoard of HealthBoundary Review BoardCentral Ferry (Edmonds) Advisory CommitteeCharter Review CommissionChildren’s CommissionChemical Dependency and Mental Health Sales Tax Advisory BoardCivil Service CommissionClimate Action AdvisoryCommunity Services Advisory CouncilConservation Futures Program Advisory BoardCouncil On AgingDevelopmental Disabilities Advisory BoardEarly Head Start Policy CommissionEECEAP Parent Advisory CommissionEmergency Management AdvisoryEthics CommissionEvergreen State Fair Advisory BoardHistoric Preservation CommissionHousing Authority Board Of CommissionsHuman Rights CommissionLake Stevens Park & Recreation Area Government Advisory BoardLaw Enforcement Officers & Fire Fighters Disability BoardsLocal Emergency Planning CommitteeLodging Tax Advisory CommitteeMarine Resources Advisory CommitteeNorth Central (Mukilteo) Ferry Advisory CommissionNorth Sound Mental Health Admin Advisory BoardNoxious Weed Control BoardPaine Field Community CouncilPaine Field Mediated Role Determination (MRD)Parks Advisory BoardPartnership to end homelessnessPerformance Audit CommitteePilchuck Development Corporation Board Of DirectorsPlanning CommissionPublic Facilities DistrictRegional Law and Justice Council Salary CommissionSno-Isle Regional Library Board Of TrusteesSnohomish County TomorrowSolid Waste Advisory CommitteeStillaguamish River Clean Water District (CWD)Tourism Promotion Area (TPA) Advisory BoardUrban Centers Design Review BoardVeterans' Assistance Fund Executive BoardWorkforce Snohomish
8. 1. New Appointment

   1. 1st Reappointment

   1. 2nd Reappointment

   1. Ex Officio
10. Snohomish County Council District (Please choose one):
    -- Select One --12345Snohomish County
12. Name
14. Home Address
16. Mailing Address (if different)
18. City
19. State
20. Zip Code
22. Telephone (Home)
23. Telephone (Work)
25. Email
27. Current Employer
29. Occupation
31. Education
33. Licenses held (if applicable)
35. Why would you like to serve on this board/commission?
37. Please explain why you are a qualified candidate, including relevant professional experience, to serve on the board/commission.
39. Please list community involvement/volunteer activities
41. How did you learn of this opportunity?
43. Do you currently serve on a Snohomish County board or commission?*
    -- Select One --YesNo

45. *2.03.060SCC - Candidates for appointment to county boards or commission must meet the following requirements:
    
     

    (1)          Possess qualifications for the appointment sought, as shown by the candidate's written documentation and any hearing testimony;
    
     (2)        If a reappointment, demonstrate the continuing benefits of retaining the board member as discussed in the executive's recommendation and a satisfactory attendance record, as determined by adopted criteria of the particular board;
     

    (3)          Reside or work in Snohomish County, or show evidence of special interest in Snohomish County, PROVIDED That a candidate may not be a County employee.
     

47. **Please be advised, effective January 1, 2022 individuals joining identified boards and commissions will be required to pass a background check.
49. By signing this Application Form, Nominee acknowledges that he/she will comply with all county policies, county code, and state law. Nominee also acknowledges that any record, including personal e-mail, prepared, owned, used, or retained by Nominee in the conduct of Board/Commission business is a public record, and Nominee agrees to produce said records to County upon request. Failure to comply with the above provisions may result in Nominee’s removal from Board/Commission.
51. Signature
53. Date
55. Please attach resume if available and either submit this form or print it and mail to

    Dave Somers, County Executive Snohomish County
    Executive Office 3000 Rockefeller Ave., MS 407
    Everett, WA 98201-4046

    (425) 388-3699 phone (425) 388-3434 fax County.Executive@snoco.org

    
    
    

    
    

    
     

     
    
    

    
    
57. Pursuant to the Public Records Act, Chapter 42.56 RCW, records submitted to Snohomish County and County Council are subject to public disclosure. The practice of the council office is to post all meeting and hearing materials to our website to ensure transparency, as well as to assist in facilitating public records requests.
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59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field