2. As an applicant for a City Council position, your name, address, and telephone number will be available to the press and public. To qualify, applicants must be a resident of District 2 at the time their application is submitted, as well as a resident of the City of Bremerton for one year. Final eligibility will be determined by the Kitsap County Elections Office. View a map of District 2 here.

   Deadline to submit this application is by Noon on Friday, March 18, 2022.

4. Date
   Date
6. First Name
7. Last Name
9. Home Phone
10. Email
12. Address
14. City
15. State
16. Zip
18. Occupation
19. Employer
21. Education
23. Local References
    Names and phone numbers
25. Why are you applying for this appointment?
27. Which of your personal and / or professional interests prompted you to apply for this appointment?
29. Have you ever served on any other Bremerton board, commission, committee or task force? If yes, please list.
31. Please list your qualifications for this appointment (include skills, activities, training, education):
33. What are your community interests (committee, organizations, special activities)?
35. Please list any accommodations you need to perform volunteer duties:
37. We welcome your willingness to serve Bremerton.
    
    Pursuant to the Washington Public Disclosure Act, (RCW 42.56), this form constitutes a public record and is subject to public release upon request. Prior to release, the following information may be redacted pursuant to RCW 42.56.250(3): Residential addresses, residential telephone numbers, personal wireless telephone numbers, personal electronic mail addresses, social security numbers, driver’s license numbers, identicard numbers, and emergency contact information of employees or volunteers of a public agency, and the names, dates of birth, residential addresses, residential telephone numbers, personal wireless telephone numbers, personal electronic mail addresses, social security numbers, and emergency contact information of dependents of employees or volunteers of a public agency.
    
    Applicants are considered for appointment without regard to race, color, religion, gender, national origin, sexual orientation, age, genetic information, marital or veteran status, or the presence of any disability.
39. Updated 3/07/2022
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field