Board Application

Personal Information

Question Title

Name (Required.)

Question Title

Business/Organization Name (Required.)

Question Title

Your Title (Required.)

Question Title

Number of Employees (Required.)

Question Title

Organization/Company Address (Required.)

Question Title

Organization/Company Website (Required.)

Question Title

Work Phone Number (Required.)

Question Title

Cell Phone Number (Required.)

Question Title

Email Address (Required.)

Business/Organization Operations

Question Title

Does your business/organization operate within Lane County: (Required.)

Yes

Question Title

Board Representation for which you are applying (Select One): (Required.)

Business/Private Industry (Category 1)

Labor (representative of labor organization) (Category 2)

Labor (rep of a joint labor-management, or union affiliated, registered apprenticeship program) (Category 2)

Community-Based Organization (Category 2)

Youth Training, Youth Employment, or Youth Education (Category 2)

Adult Education (Category 3)

Economic and Community Development (Category 4)

Wagner-Peyser (Category 4)

Vocational Rehabilitation (Category 4)

Administering programs related to transportation, housing, and public assistance (Category 4)

Philanthropic Organization (Category 4)

Complete Category 1, 2, 3, or 4 below based on the board representation checked above.

CATEGORY 1: BUSINESS SECTOR REPRESENTATION

Question Title

Authority (Select One):

I hold optimum policy-making authority.

I hold optimum hiring authority.

Question Title

Role (Select One):

Business Owner

Business Chief Executive Officer or Chief Operating Officer

Other

Question Title

If "Other" is checked, please describe your policy-making and/or hiring authority.

Question Title

Business Type:

Private Sector Large/For-Profit Business (500+ employees)

Private Sector Small/For-Profit Business (less than 500 employees)

Question Title

Describe the industry or occupation represented by your business:

Question Title

Nominating Organization (chamber/association or business trade association):

CATEGORY 2: WORKFORCE REPRESENTATIVE

Question Title

Representation (Select One):

Labor Organization

Registered Apprenticeship Program (Joint Labor-Management or Union-Affiliated)

Community-Based Organization (CBO) addressing employment needs of individuals with barriers to employment, including organizations that serve veterans or that provide or support competitive integrated employment for individuals with disabilities.

Youth Training, Youth Employment, or Youth Education Organization

Question Title

Nominating Organization:

Question Title

If you selected Community-Based Organization above, describe your experience addressing employment, training, and education needs to those with barriers to employment.

Question Title

If you selected Youth Training, Youth Employment, or Youth Education Organization above, describe your experience addressing training, employment, and education for in -school and/or out-of-school youth.

CATEGORY 3: EDUCATION REPRESENTATIVE

Question Title

Representation (Select One):

Adult Education and Literacy Provider under Title II

Higher Education providing workforce development activities (including community colleges)

CATEGORY 4: ECONOMIC DEVELOPMENT/WAGNER PEYSER/VOC REHABILITATION REPRESENTATIVE/TRANSPORTATION, HOUSING, PUBLIC ASSISTANCE/PHILANTHROPIC

Question Title

Representation (Select One):

Economic and Community Development Entity

Wagner-Peyser

Vocational Rehabilitation

Administering programs relating to transportation, housing, and public assistance

Philanthropic organization

All applicants are required to complete the following two questions.

Question Title

Why do you wish to serve on the Lane Workforce Partnership Board of Directors? (Required.)

Question Title

Please tell us about any other boards or organizations of which you are an active member. (Required.)

Question Title

Signature (please type your name) (Required.)

Question Title

Date (please enter date completed) (Required.)

Date

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100% of survey complete.

Board Application

Question Title

* Name (Required.)

Question Title

* Business/Organization Name (Required.)

Question Title

* Your Title (Required.)

Question Title

* Number of Employees (Required.)

Question Title

* Organization/Company Address (Required.)

Question Title

* Organization/Company Website (Required.)

Question Title

* Work Phone Number (Required.)

Question Title

* Cell Phone Number (Required.)

Question Title

* Email Address (Required.)

Question Title

* Does your business/organization operate within Lane County: (Required.)

Question Title

* Board Representation for which you are applying (Select One): (Required.)

Question Title

* Authority (Select One):

Question Title

* Role (Select One):

Question Title

* If "Other" is checked, please describe your policy-making and/or hiring authority.

Question Title

* Business Type:

Question Title

* Describe the industry or occupation represented by your business:

Question Title

* Nominating Organization (chamber/association or business trade association):

Question Title

* Representation (Select One):

Question Title

* Nominating Organization:

Question Title

* If you selected Community-Based Organization above, describe your experience addressing employment, training, and education needs to those with barriers to employment.

Question Title

* If you selected Youth Training, Youth Employment, or Youth Education Organization above, describe your experience addressing training, employment, and education for in -school and/or out-of-school youth.

Question Title

* Representation (Select One):

Question Title

* Representation (Select One):

Question Title

* Why do you wish to serve on the Lane Workforce Partnership Board of Directors? (Required.)

Question Title

* Please tell us about any other boards or organizations of which you are an active member. (Required.)

Question Title

* Signature (please type your name) (Required.)

Question Title

* Date (please enter date completed) (Required.)

Name (Required.)

Business/Organization Name (Required.)

Your Title (Required.)

Number of Employees (Required.)

Organization/Company Address (Required.)

Organization/Company Website (Required.)

Work Phone Number (Required.)

Cell Phone Number (Required.)

Email Address (Required.)

Does your business/organization operate within Lane County: (Required.)

Board Representation for which you are applying (Select One): (Required.)

Authority (Select One):

Role (Select One):

If "Other" is checked, please describe your policy-making and/or hiring authority.

Business Type:

Describe the industry or occupation represented by your business:

Nominating Organization (chamber/association or business trade association):

Representation (Select One):

Nominating Organization:

If you selected Community-Based Organization above, describe your experience addressing employment, training, and education needs to those with barriers to employment.

If you selected Youth Training, Youth Employment, or Youth Education Organization above, describe your experience addressing training, employment, and education for in -school and/or out-of-school youth.

Representation (Select One):

Representation (Select One):

Why do you wish to serve on the Lane Workforce Partnership Board of Directors? (Required.)

Please tell us about any other boards or organizations of which you are an active member. (Required.)

Signature (please type your name) (Required.)

Date (please enter date completed) (Required.)