Blei
RECEIVED
CITY CLERKS OFFICE
CITY OF RICBOARD OR COMMISSION APPLICATION FORM
2023 FEB -3 AM ID: 03 2-1-23
DATE:
Check one: New Appointment
Re-Appointment
NAME OF BOARD OR COMMISSION: COMMISSION ON AGING
NAME: ROSE BROOKS
HOME ADDRESS:
ZIP CODE: 94805 HOME PHONE: _ WORK PHONE:
OCCUPATION: RETIRED EMAIL ADDRESS:.
HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: 56 YEARS PLACE OF EMPLOYMENT:
REASONS FOR INTEREST IN APPOINTMENT:
I'M CURRENTLY AN ACTIVE MEMBER OF THE COMMISSION AND HAVE BEEN FOR YEARS.
TRULY ENJOY WORKING WITH THE SENIORS AND BEING A PART OF THE COMMISSION AS THE TRESURER.
FRATERNAL AND/OR CIVIC ORGANIZATIONS:
NA
EDUCATION:
N/A
REFERENCES (Minimum 5 - List Name, Address, Phone Number, and Email Address)
1. Michelle Hayes
2. Myrtle Braxton
3. Cate Burkhart o
4. Naomi Williams co
5. Rina BakerC
To the best of my knowledge the information provided is true and correct:
Dranks
2/1/2023
Signature Date
Deliver or Mail to: City Clerk Or Email to: [email protected] 450 Civic Center Plaza
Richmond, CA 94804
For Office Use Only: New Appointment: Reappointment: • • 1st 2nd • 3rd