Worknet Board Member Application Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Office Phone*Cell Phone*Email* Company Name* Company URL* Company Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Entity Represented* I am a representative of business in Merced County. I am a representative of a labor organization in Merced County. I am a representative of a community based organization that provides training to Merced citizens in order to prepare them for a job. I am a representative of a provider administering adult and literacy activities under Title II of the Workforce Innovation and Opportunity Act. I am a representative of an institution of higher education providing workforce investment activities, including community colleges. I am a representative of governmental and economic and community development in Merced County. I am a representative of the State employment services office under the Wagner-Peyser Act serving in the local area. I am a representative of the program carrying out activities under title I of the Rehabilitation Act of 1973. I am a representative of an entity in the local area providing services related to transportation, housing, and public assistance. Other (Please Indicate) Entity Represented (Other) Approximate number of local employees employed by the entity you represent?* What is your official position and what do you do at your organization?*HiddenIf you represent a business in the local area, please check all that apply:* I am the owner, chief executive, or operating officer of business I am representing. I am the executive or employer with optimum policymaking or hiring authority in the business I am representing. The business I represent provides employment opportunities that include provide employment opportunities that, at a minimum, include high quality, work-relevant training and development in the following sectors: Advanced Manufacturing Construction (Including Commercial, Public Infrastructure, Residential) Energy (Including Green Energy) Healthcare Transportation and Logistics Agriculture Water Technology I was nominated by a local business organization and/or a local business trade association. Please provide a brief description of the entity you represent?*What do you think are the critical workforce issues for our region?*What would you bring to the Worknet Merced County Workforce Development Board (e.g., talent, experience, resources, knowledge, networks)?*What value do you hope to get out of your participation on the Worknet Merced County Workforce Development Board?*The Worknet Merced County Workforce Development Board meets the second Thursday of every other month beginning in February. Will you be able to attend all six meetings? (Occasional scheduling conflicts or emergencies aside)* Yes No Additional thoughts?*Please attach your current resume.* Drop files here or Select files Accepted file types: jpg, doc, docx, png, pdf, Max. file size: 256 MB, Max. files: 2. Signature (Please print name. Signature will be captured during meeting)* I hereby certify that all statements in this Application are true and complete to the best of my knowledge and execute this Application under penalty of perjury. I further certify that if I am appointed, I will serve fairly, impartially, and to the best of my ability. Please be advised that Board Members: -Are required to take an Oath of Office -Must comply with the County’s Ethics Ordinance. -Must participate in State-mandated ethics training. -Must disclose financial interests as required by the County Code (Form 700). -Must report any conflicts of interest as required by the County Code.Date Submitted* MM slash DD slash YYYY
