The Southern Nevada Health District (Health District) requires this information of all persons who apply for appointment to the Southern Nevada Health District Public Health Advisory Board. The personal information you provide will be protected as confidential and will be used by Health District board members and staff only for official purposes, such as to communicate with prospective and appointed applicants and for demographics. It will not become part of any public document or be otherwise available to the general public. NAME: RESIDENCE ADDRESS: CITY/ZIP: MAILING ADDRESS: (if different from residence) CITY/ZIP: BUSINESS ADDRESS: CITY/ZIP: OCCUPATION: EMPLOYER: DAY PHONE: (Home/Work – select one) EVENING PHONE: (Home/Work – select one) CELL PHONE: FAX NUMBER : E-MAIL ADDRESS: Application for Appointment to the Southern Nevada Health District Public Health Advisory Board I am applying for the position of: (check ONE: if you wish to apply for more than one position, a separate application is required)
The Southern Nevada Health District (Health District) requires this information of all persons who apply for appointment to the Southern Nevada Health District Public Health Advisory Board. The personal information you provide will be protected as confidential and will be used by Health District board members and staff only for official purposes, such as to communicate with prospective and appointed applicants and for demographics. It will not become part of any public document or be otherwise available to the general public. NAME: RESIDENCE ADDRESS: CITY/ZIP: MAILING ADDRESS: (if different from residence) CITY/ZIP: BUSINESS ADDRESS: CITY/ZIP: OCCUPATION: EMPLOYER: DAY PHONE: (Home/Work – select one) EVENING PHONE: (Home/Work – select one) CELL PHONE: FAX NUMBER : E-MAIL ADDRESS: Application for Appointment to the Southern Nevada Health District Public Health Advisory Board I am applying for the position of: (check ONE: if you wish to apply for more than one position, a separate application is required)