RECEIVED
CITY CLERKS OFFICE CITY OF RICHMOND
2023. JAM 17 PM 3: 0 BOARD OR COMMISSION APPLICATION FORM DATE: 10-31-22
Check one: New Appointment
HOUSING
Re-Appointment
NAME OF BOARD OR COMMISSION: DUISOR) COMMISSiON
NAME: JAYCINE SCOT
HOME ADDRESS: RICHMOND
ZIP CODE 14804 HOME PHONE WORK PHONE:
occuPATION RETIRED DISABLED EMAIL ADDRESS:
HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: 1959 PLACE OF EMPLOYMENT:
REASONS FOR INTEREST IN APPOINTMENT
[HIS WILL BE REAPPOINTMENT FOR ME. ENJOY WHAT
AM DOING FOR THESE YEARS AND WANT TA CONTINUE.
FRATERNAL AND/OR CIVIC ORGANIZATIONS:
SNAP ORGANIZATION, THROUGH LIFE LING MEDICAL
EDUCATION:
HIGH SCHOOL DIPLOMA, MEDICAL ASSISTANT PHLEBOTOMIST
AND TWO SEMESTERS OF JUNTOR COLLEGE
REFERENCES (Minimum 5- List Name, Address Phone Numher and Email Address)
1. DEL VIN SHEPHERD
2. ANGELA ORR
3 DOLORES JOHNSON
A MECHELLE LEE
5. MARYEHZABETH SIMS
To the best of my knowledge the information provided is true and correct:
-Paycine scott DEC. 15, 2022
Deliver or Mail to: Or Email to: [email protected] 450 Civic Center Plaza
Richmond, CA 94804
For Office Use Only: New Appointment: • Reappointment: 1st 2nd • 3rd