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Name: |
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Kitsap County Resident
since: |
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My County
Commissioner is : |
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Consumer Experience: Have you or any member of your immediate family
received services related to substance abuse?
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RCW 70.96A.300
requires that the board shall be composed of not less than seven nor
more than fifteen members, who shall be chosen for their
demonstrated concern for alcoholism and other drug addiction
problems. Members of the board shall be representative of the
community, shall include at least one-quarter recovered alcoholics
or other recovered drug addicts, and shall include minority group
representation.
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| OPTIONAL - Are
you recovering from alcohol or other drug dependency?
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| OPTIONAL - What
ethnic minority group do you represent?
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| WORK EXPERIENCE
- Do you have any paid work experience in the substance abuse field?
If yes, please describe: |
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| AFFILIATIONS -
Within the past year, have you or a member of your immediate family
been employed by, or on the board of directors of any agency funded
in part by Kitsap County?
If yes, please describe: |
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TRAINING - have you received special training in the area of Human
Resources?
If yes, please describe: |
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Would you be able and willing to attend a one-day weekend retreat once
a year? |
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I understand the member responsibilities and am aware that this
appointment will entail 2 to 6 hours per month of active involvement in
Board meetings and activities. |
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Signature: |
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Date: |
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After
pressing submit, you should see a confirmation page listing your
responses. If this page does not appear or if you have any
other difficulty with this form, please contact Rebecca Pirtle (360)
337-4650 or rpirtle |
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Kitsap County provides equal opportunities
for appointment to citizen advisory boards. |
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This form must accompany the Volunteer
Application for Appointment to a Board, Commission, Committee or
Council |
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