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Board Application

Personal Information
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.)
Business/Organization Operations
Does your business/organization operate within Lane County:(Required.)
Board Representation for which you are applying (Select One):(Required.)
Complete Category 1, 2, 3, or 4 below based on the board representation checked above.
CATEGORY 1: BUSINESS SECTOR REPRESENTATION
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):
CATEGORY 2: WORKFORCE REPRESENTATIVE
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.
CATEGORY 3: EDUCATION REPRESENTATIVE
Representation (Select One):
CATEGORY 4: ECONOMIC DEVELOPMENT/WAGNER PEYSER/VOC REHABILITATION REPRESENTATIVE/TRANSPORTATION, HOUSING, PUBLIC ASSISTANCE/PHILANTHROPIC
Representation (Select One):
All applicants are required to complete the following two questions.
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.)
Date
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