- - - - - - - - - - - - - - - - - - - - ---

TOWN OF BARRINGTON, RHODE ISLAND

This form will be used by any person interested in serving on the various committees of the Town.

Boards and Commissions Application

Name: RI e,/i"' v~~ r:. $"ra_p I e s Jv:. I

Address: Home: ~ /3e..v~v ,,:½fiv1'--

Business: N /A
I
Email address:

Telephone No.: Home _,- ~ - -

----·
- .9ffiee:
VOLUNTEERING SERVICES TO: Co nl )'),) irt~ t . i!/~-1 A,.,,.,.ref) Cf a,fui-1.s
Name of Committee

EDUCATION: School City, State Degree

High School: _M_.._.t_._.__.H,_,_"-=~:....:
' fl-..;.;t:....:(J'"'"i1.:........,.,,.~t"""
',k.,..e:"""'Q"'!-r,.....G~ 1.:..:/1_._,-'-M_,_A=--=----------
....
1
College: _ _c_.-=--o....,,(µ"--~'---(t=t.d"'-'-"-o---"'Ct"---'.t'-"l-"--e-i-1..... .t _C=0.a.alo'"'-
e,.,.. ·....
i;,,__ G-'-1.S,~e'-':0.________B____-=u.~S'---i-'--'!l....,.(...c.$=5-
·:>.....
0ther. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ __

EMPLOYMENT HISTORY: (list most recent employment first) ,

Name of Company City, State Type of Work

--L]~t~llvi~·-=-e :..L~____,_S lL::.:.v.i.t=K:1f:µ...

a.!.¥ S .._I¼~~1'-'-k::,_____-==.s-'-'~"-i1\.:..+--,..,-'-'-A'--_ ___;:=--:..,"..:-+....,,__~u..l1:.=ttl/\..cc:
(I e~,. ,~ l'I t pn {J CUA'-l'..L.-
Have you ever served, on a committee ,nBarrington? --l~'""t'.--~-- - - - -- - -

In another community? f- Please list: H&~ S In ~ Wc/\t le'... S R. (

Other volunteer experience· (name of organization, position).

Lt 4 rJ,.,r. v ~ h ,· p R. I I<h A. w tr J v-a.p h.l'. ~~

;d.H\.,t-
Ab il I Ilj Pf u.~ ,
How long have you resided
,~c,in Barrington?
'Vj [u~tf-(i e.11 Sl i '" c; tr~c hrL
31yegi,.Vs t: I,f (._a~ yr: 1,Qk.)
1
Previous address. _ A...:v...;.t.L-----'b-'-
- {_c -4--,:C:;__
0 _ _ _ _ _ _ _ _ _ _ _ _ __ _
Please explain briefly your reason(s) for applying for an appointment to this particular
committee:

((tE.r u. s ~ f' ~ rt. aPP ot KittA-{1/L(,f Ul i; {I\ Cl{ ~' ~ (&,.A-

Whal special talents and experience do you possess which would be useful to the
committee? ·

Would you be representing any organization? 10:J

If yes, which one? _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ _ __ __

THE TOWN OF BARRINGTON DOES NOT DISCRIMINATE ON THE BASIS OF RACE,

COLOR, NATIONAL ORIGIN, SEX, RELIGION , AGE OR DISABILITY IN THE
EMPLOYMENT OR PROVISION OF SERVICES.

Please be advised that pursuant to Chapter 2 of Title 38 of the Rhode Island General laws
all the Information provided b~ you to the town in connection with your application for J~
appointment to a town board/ comminee is deemed a Public Record $ubject to disclosure
to any person who requests the same.

Applicant's Signature: /t. /...iul ~ .,

Date. _ _.;;.!"_-_,('-']_-_,(_....8."__ _ _ _ _ _ _ _ __

RETURN THIS FORM TO·TOWN CLERK

TOWN HALL, 283 COUNTY ROAD
BARRINGTON, RI 02806