Fillable City of Tukwila Application for Appointment BOARDS AND (City of Tukwila)

Fill Online, Printable, Fillable, Blank City of Tukwila Application for Appointment BOARDS AND (City of Tukwila) Form

Use Fill to complete blank online CITY OF TUKWILA (WA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

City of Tukwila Application for Appointment BOARDS AND (City of Tukwila)

On average this form takes 16 minutes to complete

The City of Tukwila Application for Appointment BOARDS AND (City of Tukwila) form is 6 pages long and contains:

  • 1 signature
  • 26 check-boxes
  • 47 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Tukwila

BROWSE CITY OF TUKWILA (WA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Please note that upon submission, all information on this document becomes public record. For further clarification
regarding this application or more information regarding boards and commissions please call 206-433-1850.
City of Tukwila
Tukwila City Hall
6200 Southcenter Blvd
Tukwila, WA 98188
Phone: (206) 433-1800
Email: BoardsComms@tukwilawa.gov
Website: www.tukwilawa.gov
Application for Appointment
BOARDS AND COMMISSIONS
Please complete the ENTIRE application form. Submitting a resume is optional.
DATE:
NAME:
Last First M.I.
ADDRESS:
Street City Zip
M
AILING ADDRESS (if different): ___________________________________________________________________________
HOME PHONE: MOBILE PHONE: _____________________________________________
EMPLOYER: E-MAIL: ____________________________________________________
Please check all that apply to you within Tukwila city limits:
Resident Business Owner/Representative
School District Representative High School Student
I wish to be considered for appointment to the following board or commission (check all that apply):
COMMISSIONS: BOARDS & COMMITTEES:
Arts Community Police Advisory
Civil Service Human Services
Equity & Social Justice Library
Parks Lodging Tax
Planning
Other/Special Committee: __________________________________________________________________
H
AVE YOU PREVIOUSLY SERVED ON ONE OF THESE BOARDS OR COMMISSIONS?
Yes No
I
f “yes”, please list: ______________________________________________________________________________________
AVAILABLE TO ATTEND MEETINGS: Daytime Evenings
RECEIVED
Boards & Commissions Application
Page 2
Please note that upon submission, all information on this document becomes public record. For further clarification
regarding this application or more information regarding boards and commissions please call 206-433-1850.
Please describe your interest in serving on a board, commission or committee and include your
qualifications for the position. (Please limit your response to 500 words or less.)
Boards & Commissions Application
Page 3
Please note that upon submission, all information on this document becomes public record. For further clarification
regarding this application or more information regarding boards and commissions please call 206-433-1850.
Professional/Community Activities (organizations, clubs, service groups, etc.):
Hobbies/Interests:
Other comments/additional information for consideration:
Boards & Commissions Application
Page 4
Please note that upon submission, all information on this document becomes public record. For further clarification
regarding this application or more information regarding boards and commissions please call 206-433-1850.
PERSONAL INFORMATION (OPTIONAL)
The City of Tukwila is committed to inclusiveness and outreach to all Tukwila residents to ensure that Tukwila
boards and commissions are reflective of the community we serve. Providing information in the section below
is voluntary but will assist in achieving this goal.
How do you identify?
RACE/ETHNICITY: _____________________________________________________________________________
GENDER: ____________________________________________________________________________________
SEXUAL ORIENTATION: ________________________________________________________________________
PREFERRED PRONOUNS: ______________________________________________________________________
Do you have a disability as defined by the Americans with Disabilities Act? Y N
Generation Range
Under 30 31-40 41-50 51 – 60 61 – 70 Over 70
Applicant’s Signature Date
FOR CITY USE ONLY:
APPOINTED: Yes No TERM EXPIRES:
click to sign
signature
click to edit
CITY OF TUKWILA
Boards & Commissions
6200 Southcenter Blvd., Tukwila, WA 98188 206-433-1800
Notification and Authorization for
Background Investigation Disclosure Statement
In compliance with RCW 43.43.830-845, all applicants who have been offered a position as a
volunteer, and in which position the person may have unsupervised access to children less than
sixteen years of age, to developmentally disabled persons, or to vulnerable adults, are required to
disclose the following information:
1.
Have you ever been convicted of any crime against children or other
persons*?
* "Crime against children or other persons" (as identified in RCW 43.43.830) means a conviction of any of the
following offenses: Aggravated murder; first or second degree murder; first or second degree kidnapping;
first, second or third degree assault; first, second or third degree assault of a child; first, second or third
degree rape; first, second or third degree rape of a child; first or second degree robbery; first degree arson;
first degree burglary; first or second degree manslaughter, first or second degree extortion; indecent liberties;
incest; vehicular homicide; first degree promoting prostitution; communication with a minor; unlawful
imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment;
child abuse or neglect as defined in RCW 26.44.020; first or second degree custodial interference; first or
second degree custodial sexual misconduct; malicious harassment; first, second or third degree child
molestation; first or second degree sexual misconduct with a minor; commercial sexual abuse of a minor;
child abandonment; promoting pornography; selling or distributing erotic material to a minor; custodial
assault; violation of child abuse restraining order; child buying or selling; prostitution; felony indecent
exposure; criminal abandonment; or any of these crimes as they may be renamed in the future.
Yes No
2.
Have you been convicted of crimes relating to financial exploitation where
the victim was a vulnerable adult?
Yes No
3.
Have you been found in any dependency action under RCW 13.34.040 to
have sexually assaulted or exploited any minor or to have physically abused
any minor?
Yes No
4.
Have you been found by a court in a domestic relations proceeding under
Title 26 RCW to have sexually abused or exploited any minor or to have
physically abused any minor?
Yes No
5.
Have you been found in any disciplinary board final decision to have sexually
or physically abused or exploited any minor or developmentally disabled
person, or to have abused or financially exploited a vulnerable adult?
Yes No
6.
Have you been found by a court in a protection proceeding under Chapter
74.34 RCW, to have abused or financially exploited a vulnerable adult?
Yes No
Applicant: __________________________
Revised: 1/22/2014
T
he City of Tukwila shall make an inquiry to the Washington State Patrol and/or Southeastern
Security Consultants, Inc. regarding an applicant's conviction record, disciplinary board final
decision, or civil adjudication record. Applicants will be notified of the results within 10
working days of receipt of this information by the City of Tukwila. A copy of the
background screening results will be made available to the applicant upon request.
I acknowledge that I have read the entire Notification and Authorization for Background
Investigation Disclosure Statement, which I understand the requirements, and I grant permission
to the City of Tukwila to make inquiry to the aforementioned organizations under the provisions of
this law. Pursuant to RCW 9A.72.085, I certify under penalty of perjury under the laws of the
State of Washington that the foregoing is true and correct.
TO EXPEDIATE THE BACKGROUND CHECK PROCESS
PLEASE PROVIDE ALL REQUESTED INFORMATION.
INFORMATION WILL BE KEPT CONFIDENTIAL.
***PRINT CLEARLY***
Applicant's Name (Print)
Date of Birth
Street Address
Social Security Number (application cannot be processed without SSN)
City State Zip Code
Phone Number 1:
Applicant’s Signature Date
Phone Number 2:
City of Tukwila Processing Agent
Processed Date
Results Date:
Results:
PASS
FAIL
Applicant Notified:
No Yes
Date:
Notes:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

City of Tukwila Application for Appointment BOARDS AND (City of Tukwila)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document