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HomeMy WebLinkAbout03/04/2013 Item 060MOHAVE COUNTY REQUEST FOR BOARD ACTION FORM FORMALACTION a CONSENT RESOLUTION OTHER INFORMATION ONLY F7 FROM: Joy Brotherton, Supervisor, District IV CONTACT /EXT: Susie Parel- Duranceau Ext. 4780 DATE: February 21, 2013`' BOS MEETING DATE: March 04, 2013 SUMMARIZE THE ISSUE & DESIRED ACTION CLEARLYIATTACH BACKUP MATERIAL: Approve the appointments of Anne Riley, Tara Newman, Betsy Parker, Dave Wolf, Sandy Breece, Shawna Schneikart, Dave White, Sarah Skemp, and Eva Lillard to the Mohave/La Paz Local Workforce Investment Board (LWIB) - Youth Council for a four (4) year term expiring December 31, 2016. The creation of the Youth Council as a sub -group of the Mohave /La Paz Local Workforce Investment Board (Mo /Paz LWIB) is required by the Workforce Investment Act of 1998, Public Law 105 -220, Section 117 (h), which prescribed the required representation from the following sectors: (1) LWIB Sector member with expertise in Youth Policy; (2) Youth Services Agencies; (3) Local Public Housing Authority; (4) Parent of Eligible W.I.A. Youth (5) Other individuals with experience In Youth activities; and (6) LWIB Chairperson. The members of the Mo/Paz Youth Council are appointed by the respective Boards of Supervisors for Mohave County and La Paz County and certified by the Governor of the State every two (2) years. The Mo/Paz Youth Council is tasked to develop a local plan relating youth activities; recommend eligible providers of youth activities; and conduct oversight of youth policies and activities in the local area. RECOMMENDED MOTION: Approve the appointments of Anne Riley, Tara Newman, Betsy Parker, Dave Wolf, Sandy Greece, Shawna Schneikart, Dave White, Sarah Skemp, and Eva Lillard to the Mohave/La Paz Local Workforce Investment Board (LWIB) - Youth Council for a four (4) year term expiring December 31, 2016. Reviewed and Approved By: County Attorne /� Human Resources E-1 Finance Q County Manager Approved as Requested Q Continued to Acknowledged receipt and referred to: Board Action Taken: No Action Taken 0 Disapproved 0 Q Approved with the following changes: s a Filing Information and Retrieval Filed Bid Filed Agreement BOS Resolution Filed Yearly Correspondence Filed Petition Filed Dedication Filed Land Sold Filed Land Acquired Filed Franchise ID Resolution Filed Improvement District Filed Other CS Rerno 419 Date Routed: Additional Information: XC: s a a Human Resources Department MEMORANDUM DATE: November 21, 2011 TO: Susie Parel - Duranceau, Deputy County Manager FROM: Marcia Trylch, Human Resources Assistant RE: James D. White - Completed Background Information The Human Resources Department has completed the required Background Investigation on the requested appointee to the Mohave/La Paz Local Workforce Investment Board — Youth Council and has found that they meet Mohave County's background requirements. With a copy of this letter to the Clerk of Board of Supervisors, I am forwarding the original application. A copy of the application has been attached herewith for your records. C: File Clerk of the Board coo Human Resources Department MEMORANDUM DATE: February 21, 2012 TO: Susie Parel- Duranceau, Deputy County Manager FROM: Marcia Trylch, Human Resources Assistant RE: Eva Olvera - Completed Background Information The Human Resources Department has completed the required Background Investigation on the requested appointee to the Mohave/La Paz Local Workforce Investment Board — Youth Council and has found that they meet Mohave County's background requirements. With a copy of this letter to the Clerk of Board of Supervisors, I am forwarding the original application. A copy of the application has been attached herewith for your records. C: File Clerk of the Board I+rw *(,Oc) u eta -Vd-- -MOHAVE COUNTYHUMAN RESOURCES DEPARTMENT P.O. Box 7000 809 E. Beale Street Kingman, Arizona 86402-7000 0 (928)7513-0736 Fax (928)753-0783 www.co.mohave.az.us TDD (928)753-0726 Geoff Riches Human Resources Director MEMORANDUM Date: February 28, 2005 COpY To: Susie Parel-Duranceau, Community Development Director From: Kristiea Jones, Human Resources Assistant - Re_ Completed Background Investigation The Human Resources Departmentl1has;completed the required Background I rf Investigation on the requested reappointed appointees.--as shown below and they meet Mohave Countys.,;bFCckq0ouod' requirements,.-There for appointment to the ..; background '44. Mohave/La Paz YoUth Qbuhj' �l i§-'fecoriffnended. David IVILWALlin, Helen Hutchins -Don-Van Brunt ,John Hansen Joshua Frisby John Crabtree Robert Ortega --Sandra Breece - Paula Lupo --Shawna Schneikart . Alan Whipple 12/28/04' I 6/30/W -11. IIAO104 A background is not.required for cu forthe appointment'of David Wolf- Cc: File tEj tFe B'0'_;i:r:d--. rrent'Mbhave County employee, as is the case I+crn W Human Resources Department IV MEMORANDUM DATE: February 27, 2008 TO: Susie Parel- Duranceau, Community and Economic Development Director FROM: Ray Osuna, Director of Hu n rces SUBJECT: Tara Newman, Background Information Tara Newman, an applicant for the Youth Council with Community and Economic Development, is currently a Mohave County employee with the Probation Department. Tara has successfully completed a background check prior to her employment, and therefore, Human Resources will not require another background check. C: File Clerk of the Board I +C VVI (-�o 928.753 0736 700 West Beale street FX: 928.753.0783 Ramon R. Osuna PO Box 7000 Steve Seney Human Resources l)irednr Kingman. AZ 86402 Employment 5ervms Manager TO: FROM: MEETING DATE: AGENDA SUBJECT: Board of Supervisors Susie Parel - Duranceau, Director Community Services Department March 41 2013 Appointment and Reappointments to the Mohave /La Paz Local Workforce Investment Board — Youth Council BOARD MOTION: Appoint Anne Riley, Tara Newman, Betsy Parker, Sandy Breece, Dave Wolf, Dave White, Shawna Schneikart, Sarah Skemp, and Eva Lillard to the Mohave /La Paz Local Workforce Board - Youth for a four- (4) year term expiring December 31, 2016. BACKGROUND: The creation of the Youth Council as a sub- group of the Mohave /La Paz Local Workforce Investment Board (Mo /Paz LWIB) is required by the Workforce Investment Act of 1998, Public Law 105 -220, Section 117 (h), which prescribed the required representation from the following sectors: (1) LWIB Sector with expertise in Youth Policy;(2) Youth Service Agencies; (3) Local Public Housing Authority; (4) Parent of Eligible W.I.A. Youth; (5) Other Individuals with experience in youth activities; and (6) LWIB Chairperson. The members of Mo /Paz Youth Council are appointed by the respective Boards of Supervisors for Mohave County and La Paz County and certified by the Governor of the State every two (2) years. The Mo /Paz Youth Council is tasked to develop a local plan relating to youth activities; recommend eligible providers of youth activities; and conduct oversight of youth policies and activities in the local area. The Mo /Paz LWIB By -Laws was adopted on April 6, 2000. Article III (B) APPOINTMENTS, provides a four -year term of office for the LWIB members expiring December 31, 2016. The reappointments and /or new appointments of the members of the Mo /Paz LWIB for the next 4 -year term correspond to the election of the respective Boards of Supervisors for both counties every 4 years. Therefore, the reappointments and /or new appointments of the members of the Mo /Paz LWIB are made by the newly elected Boards of Supervisors for each county. Appointment to fill a vacancy, caused other than the expiration of the term, shall be for the unexpired portion of the term. Mohave County Reappointments and Appointments The attached MO /PAZ LWIB — YOUTH COUNCIL REQUIRED MEMBERSHIP CHART reflects the required sectors and the proposed representatives for Mohave County and La Paz County. Mohave County will appoint three (3) LWIB members; three (3) Youth Service Agencies, Juvenile Justice & Law Enforcement members; one (1) Public Housing Authority member; five (5) Individuals with Experience Relating to Youth; one (1) Parent of Eligible Youth member; and one (1) Job Corps member. ,a F Youth Council members previously appointed in the last term requested to be reappointed for the new term. Background investigations were successfully completed for all reappointments and new appointments. A. LWIS Member: REAPPOINTMENT 1. Anne Riley, Mohave Community Federal Credit Union, District I B. Youth Service Agencies Juvenile Justice & Law Enforcement: REAPPOINTMENTS: 1. Tara Newman, Mohave County Probation 2. Betsy Parker, Western Arizona Vocational Education (WAVE) C. Public Housing Authority: REAPPOINTMENT: 1. Dave Wolf, Mohave County Housing Authority D. Individuals with Experience Relating to Youth Activities: REAPPOINTMENTS: 1. Sandy Breece, Telesis Center for Learning 2. Shawna Schneikart, Lake Havasu City Unified School District 3. Dave White, Mohave Community College APPOINTMENT: 1. Sarah Skemp, Lake Havasu City Unified School District E. Job Corps REAPPOINTMENT: 1. Eva Lillard, Job Corps — Yuma OA MOHAVE/LA PAZ WORKFORCE INVESTMENT AREA YOUTH COUNCIL. MEMBERSHIP PER W.I.A. SECTION 117 (H)(2) Total members: 18 REQUIRED SECTOR AGENCY OR BUSINESS REPRESENTATIVE Members of LWIB (MI) VACANT VACANT (representing private (M2) VACANT VACANT business, labor, economic (M4) Mohave Credit Union Anne Riley, Private development, community (L1) CB Real Estate Chonna Marshall, Private based organizations, (L2) Arizona Public Service John Croteau, Private education, and one -stop providers) with special interest or expertise in Youth Policy (5) M = Mohave County L = La Paz County (LYS) La Paz Career Center Ramona Duran (MLE) Mohave County Probation Tara Newman Youth Service Agencies (MYS) Western Arizona Vocational Betsy Parker Juvenile Justice & Education (WAVE) Law Enforcement (4) (MYS) VACANT VACANT Public Housing Authority (1) Mohave County Housing Authority Dave Wolf Parents of Eligible Youth VACANT Seeking Assistance under VACANT W.I.A. Title IC (1) Individuals, including former (Ml) Telesis Center for Learning Sandy Breece participants and (M2) LHC Unified School District Sarah Skemp* representatives of (M3) LHC Unified School District Shawna Schneikart organizations, that have (M4) Mohave Community College Dave White experience relating to youth (L1) Pathways Counseling and Mediation Linda Paquette activities. (6) (MY) VACANT VACANT Job Corp (1) Job Corps —Yuma Eva Lillard Contingent upon the approval of the Mohave /La Paz Local Workforce Investment Board and respective Board of Supervisors. 1/22/2013_ . zi MO/PAZ LWIB REQUIRED MEMBERSHIP PER W.I.A. SECTION 117 (A)(2) REQUIRED SECTOR AGENCY OR BUSINESS REPRESENTATIVE Private Business = 50% + 1 of (M1) Kingman Area Chamber of Commerce Pam Wilkinson (District 4) 36 = 19 for Majority (M2) Nucor Steel Corporation Doug Adams (District 4) (M3) Lake Havasu Area Chamber of Commerce Lisa Krueger (District 3) (M4) Mohave Credit Union Anne Riley (District 1) M = Mohave County L = La Paz County (MS) Little Caesar's Pizza (M6) Management Training Corporation Billy Tucker (District 2) Jerry Sternes (District 4) (M7) Frontier Communications Tom Gustafson (District 2) (M8) Pioneer Land and Realty Emma Jean Watson (District S) (M9) Valley View Medical Center Susan Scharlers (District 2) (M10) Laron, Inc. John Hansen (District 1) (M11) The Mahoney Group Doug McKee (District S) (M12) Unisource Energy Mike Roberts (District 1) (M13) Havasu Regional Medical Center Carol Dumais (District 3) (M14) Whitman Cowlitz Professional Consultants Don Van Brunt (District 3) (M15) Brook -Clark & Associates Don Clark(District S) * (L1) Colorado River Regional Crisis Shelter Barbra Hunter (La Paz County) (L2) CB Real Estate Chonna Marshall (La Paz County) (L3) VACANT VACANT (La Paz County) (L4) Arizona Public Service John Croteau (La Paz County) (L5) National Bank of Arizona Bernadette Jokkel (La Paz County) (L6) VACANT VACANT (La Paz County) Education (1) (M1) Mohave Community College (L1) Arizona Western College Michael Kearns Randy Hartless Labor (2) VACANT IBEW # 769 VACANT Allan Bell Community Based Organizations (2) Goodwill Industries of Northern Arizona Parker Area Alliance for Community Empowerment, Inc. (PAACE Elisabeth McGinlay (Mohave County) Duce Minor (La Paz County) Economic Development (2) Kingman Airport Authority Partnership for Economic Development Robert Riley Gary Kellogg Wagner - Peyser /TAANeterans Workforce Programs, Employment and Outreach/ State Unemployment Program/ Migrant Seasonal David Blythe Workers JOBS & TANF Vicki De Los Reyes Community Services Block Grant Gina Whittington WIA Title I Youth Program, Dislocated Workers One -Stop Programs Program & Senior Community Services Employment Jennee Miles WIA Title I Adult Program and Adult Basic Education Lillian Miller DES /RSA Rehabilitation Services Lucy Jones* HUD Employment & Training Susie Parel - Duranceau JOB CORPS Tscherina Telesford* *New Appointments 1/22/2013 - i. Human Resources Department RECEIVED MEMORANDUM JUL 0 5 2012 CLERK OF THE BOARD DATE: July 3, 2012 TO: Susie Parel - Duranceau, Deputy County Manager FROM: Marcia Trylch, Human Resources Assistant RE: Elizabeth Parker- Completed Background Information The Human Resources Department has completed the required Background Investigation on the requested appointee to the Mohave /La Paz Local Workforce Investment Board — Youth Council and has found that they meet Mohave County's background requirements. With a copy of this letter to the Clerk of Board of Supervisors, I am forwarding the original application. A copy of the application has been attached herewith for your records. C: File Clerk of the Board �E MOHAVE COUNTY APPLICATION APPOINTMENT TO BOARDS OR COMMISSIONS Please return completed application to: MOHAVE COUNTY CLERK OF THE BOARD'S OFFICE reea 700 W. BEALE ST, P.O. BOX 7000, KINGMAN, AZ 86402 -7000 RECEIVED JUL 05 2012 CLERK OF THE BOARD Phone: 928 - 753 -0731, Extension 4731 Fax: 928 - 753 -0732 TDD: 928 - 753 -0726 The application form must be completed in sufficient detail to allow comprehensive review and evaluation. Issuance or acceptance of this application form does not create an obligation in any manner for Mohave County. In no case shall acceptance of an application constitute assurance of consideration, and an applicant may be required to submit additional application information to be considered for appointment to a Mohave County board or commission. 1. POSITION FOR WHICH YOU ARE INTERESTED IN SERVING ON (Check more than one if you wish): It 2. Parker Elizabeth (Betsy) LAST NAME FIRST NAME MI 3. Kingman AZ 86401 STREET ADDRtss CITY STATE ZIP MAILING ADDRESS (if different from above) CITY STATE ZIP 4. HOME PHONE WORK / CELL PHONE: 5. MESSAGE CONTACT: Greg Parker NAME ADDRESS PHONE # 6. EMAIL ADDRESS: 7. Are you a registered voter? x YES ❑ NO 8. Do you live in the County Limits? x❑ YES ❑ NO 9. Do you live in the city limits? x YES ❑ NO; If YES, identify which city: Kingman 10. Are you available for evening meetings? x YES ❑ NO 11. Are you available for early morning meetings? x YES ❑ NO 12. Are you available for lunch meetings? x YES ❑ NO 13. Are there any days of the week you are not available for any meetings? xYES ❑ NO; If YES, identify which day(s) you are not available: ❑ MON ❑TUE x WED ❑ THU ❑ FRI Wednesdays are my governing board meeting days so sometimes it may be difficult 14. If appointed, please indicate which address you wish your mail to be sent: x WORK/BUSINESS ❑ HOME Work/Business Address: 15. Have you been known to previous schools, employers or references by another name? ❑ YES ❑ NO If yes, please provide name(s) 16. If you possess a valid driver's license, check the class number and complete the following: Commercial Driver's License (CDL): ❑ A ❑ B ❑ C List Special Endorsements Other Driver's License: ❑ D 11 M MISC.- Please Specify: Driver's License — tate:AZ Board of Adjustment Board of Health Building Code Advisory Board Extension Advisory Board Industrial Development Authority Libra — Citizens Advisory Board Merit Commission Parks Advisory Committee Planning and Zoning Commission Self Insurance Retention/Employee Benefit Trust Public Land Use Committee Workforce Investment Board Transportation Commission Other Please indicate): Youth Council x It 2. Parker Elizabeth (Betsy) LAST NAME FIRST NAME MI 3. Kingman AZ 86401 STREET ADDRtss CITY STATE ZIP MAILING ADDRESS (if different from above) CITY STATE ZIP 4. HOME PHONE WORK / CELL PHONE: 5. MESSAGE CONTACT: Greg Parker NAME ADDRESS PHONE # 6. EMAIL ADDRESS: 7. Are you a registered voter? x YES ❑ NO 8. Do you live in the County Limits? x❑ YES ❑ NO 9. Do you live in the city limits? x YES ❑ NO; If YES, identify which city: Kingman 10. Are you available for evening meetings? x YES ❑ NO 11. Are you available for early morning meetings? x YES ❑ NO 12. Are you available for lunch meetings? x YES ❑ NO 13. Are there any days of the week you are not available for any meetings? xYES ❑ NO; If YES, identify which day(s) you are not available: ❑ MON ❑TUE x WED ❑ THU ❑ FRI Wednesdays are my governing board meeting days so sometimes it may be difficult 14. If appointed, please indicate which address you wish your mail to be sent: x WORK/BUSINESS ❑ HOME Work/Business Address: 15. Have you been known to previous schools, employers or references by another name? ❑ YES ❑ NO If yes, please provide name(s) 16. If you possess a valid driver's license, check the class number and complete the following: Commercial Driver's License (CDL): ❑ A ❑ B ❑ C List Special Endorsements Other Driver's License: ❑ D 11 M MISC.- Please Specify: Driver's License — tate:AZ 17. Have you ever been convicted of any violation of the law inclwding:_moving traffic violations? You must answer yes if you. have any convictions, in any state, no matter how long ago, whether felony or misdemeanor, even if they have been set aside, vacated, pardoned, expunged, dismissed or appealed, whether or not your civil rights were restored, you successfully completed probation, went to trial, entered a guilty plea or a no contest plea? ❑ YES x NO If yes, please explain all convictions as accurately and completely as possible. Convictions will be evaluated in relation to the particular appointment to a board or commission for which you are applying for and will not necessarily disqualify you for an appointment (Attach additional sheets as necessary). PLEASE NOTE: Prior to considering an appointment to, a Board or Commission, Mohave County will require you to undergo and pass a thorough background investigation for the purpose of having a. criminal history review. Any false statement or omission will be considered .falsification of your application and grounds for immediate non- consideration of an appointment to a Mohave County Board or Commission. EDUCATION & TRAINING 18. ELEMENTARY AND SECONDARY EDUCATION: Did you receive a High School Diploma or G.E.D.? x YES ❑ NO 19. COLLEGE AND TRADE SCHOOLS: NAME & LOCATION CREDIT MAJOR TYPE OF DEGREE HOURS DEGREE AWARDED Purdue University Education Bachelor of x YES ❑ NO Science University of Arizona Educational Leadership MA ED x YES ❑ NO ❑ YES ❑ NO 20. List appointment - related licenses, registrations, certificates or professional memberships: (Copy must be attached if a requirement of the appointment for which you are applying) DESCRIPTION NUMBER /STATE ISSUING EXPIRES School Superintendent AZ 2018 21. MILITARY SERVICE: ❑ YES x NO If "YES ", please complete the following: Branch of Service: Date Entered: Date Separated: Are you currently a member of a U.S. Reserve or National Guard unit? ❑ YES ❑ NO If "YES ", list current assignment: 22. EMPLOYMENT HISTORY: Beginning with your current or most recent employer (including volunteer experience), list your employers and volunteer service for the last 10 years of employment/service. Provide complete and accurate addresses of former employers and agencies to which you volunteered. Attach additional sheets as necessary. You may include a resume; however, the employment history section must be fully completed UNLESS YOUR RESUME PROVIDES ALL OF THE INFORMATION REQUESTED BELOW. MAY WE CONTACT YOUR PRESENT EMPLOYER? ❑ YES ❑ NO A. Company: KUSD #20 Phone Number:(928 7535678 ) Address /City/State: 3033 Mac Donald.Ave Start Date: 1984 End Date:2009 Your Title: Assistant Superintendent Duties (be specific): management and operation of students, teachers and staff. Reason for Leaving: RETIRED Name of Supervisor /Reference Contact: Roger Jacks Phone Number:( see above ) r _ s B. Company:WAVE JTED #50 Phone Number:(928 753 -0747 ) Address /City /State: 700 W. Beale St. Start Date: 2009 End Date: employed Your Title: Superintendent Duties (be specific): Five -f igh' schools supervision of CTE programs in Mohave and La Paz county. s" Reason for Leaving: still employed Name of Supervisor /Reference Contact: C. Company: Start Date: Your Title: Reason for Leavi End Date: Name of Supervisor /Reference Contact: Company:_ Address /C Start Date: Your Title: Reason for nd Date: Name of Supervisor /Reference Contact: E. Company: Address /City/State: Start Date: End Your Title: Reason for Leaving: Name of Supervisor /Reference Contact: Phone Number: Duties (be specific): W, Phone Number: ( ) Phone Nugnber:( ) Duties (be s Phone Number: (be Fil Phone Number: ( ) 23. Have you been fired, terminated r requested to resign (instead of termination) from any employment or volunteer position for mis(-nduct or unsatisfactory service in the past ten (10) years? ❑ YES x NO 24. If yes, please identify the name of the employer or agency and explain the circumstances surrounding the severance of your employment or volunteer relationship: _ist all civil actions in which you were a party, other than divorce proceedings: ❑ NONE Date Location Nature of action or proceeding Disposition /Court Action 25. List any other experience, knowledge and/or skills that you feel would especially qualify you for the Boards or Commissions in which you are interested: Thirty years in education 26. Have you ever or are you now on any public Boards and /or Commissions or Committees? xYES ❑ NO If YES, please list the Boards /Commissions /Committees, including length of service: BOARD /COMMISSION /COMMITTEE LENGTH OF SERVICE DATES School Superintendent Date: -L -ee i - Gil 2. Roger Jacks 27. In what way do you feel you will benefit the Public by serving on the particular Board(s) or Commission(s) you have selected in Question #,1 n Active participatiory in youth progrpms and 9ducationo 28 29. REFERENCES: Give names and addresses of three people, not relatives, who have knowledge of your skills, experience and abilities. NAME BUSINESS /OCCUPATION ADDRESS PHONE 1. Mike File School Superintendent Date: GASharelF0RMS%APPL1Ta1ent Bank A plication -02112003.doc 2. Roger Jacks School Superintendent 3. Riley Frei School superintendent READ THE FOLLOWING STATEMENT CAREFULLY AND SIGN Application IS INVALID unless SIGNED BY THE APPLICANT I certify that the facts set forth on this application are true and complete, and I understand any misrepresentation shall be sufficient to remove my applicatio fr consideration. Please Initial /Date: I authorize Mohave County and any agent acting on its behalf to conduct an inquiry into any information related to my application, which may include a criminal background check. If selected to a Board or Commission, all personal data (except Social Security Number) will e a matter of public record, subject to public disclosure laws pursuant to ARS § 39 -121. IT Please Initial /Date: I certify that I understand, if appointed to a Board or Commission, I am subject to Arizona Open Meeting Law pursuant to ARS § 38 -431, and conflict of int s outlined in ARS § 38 -503, and the requirements of ARS § 38 -201 (D) and (E) requiring compliance with the Fed e I ltary Selective Service Act, 50 U.S.C. § 453, or that I am exempt from the same. Please Initial /Date: If selected, I will be provided specific information relevant to the above referenced Arizona Revised Statutes. The process of my selection may include interviews by the Board or Commission that I wish to join, as well as, an interview by the full Board of Supervisors, and an official vote for or against my appointment, in a regularly scheduled Board of Supervisors meeting. /-'\ Signature (Do not print): ,��' Date: GASharelF0RMS%APPL1Ta1ent Bank A plication -02112003.doc A Board or Commission Member's Ethics Code As a Board or Commission member, I believe that the primary purposes of a Board or Commission are to achieve effective and wise guidance of the County through group thinking and action, to raise the standards of the Board or Commission membership and to improve the level of services to the County that supports it. I realize that mine is a County trust, that I represent all the people and that I have a duty to the County as well as to the Board or Commission. I pledge myself, therefore, to be sensitive to my obligations and relationships in this trusteeship. I subscribe to the code of an ethical person, remembering that ethics refers to what a person is morally obliged to do or not to do in a given situation. I believe that Board or Commission service can be an expression of democratic citizenship, signifying a willingness to accept County responsibility and the charge to preserve the popular control of American public services. Respecting the dignity and worth - of the individual, I shall base my relations with people on their qualities as individuals without distinction as to race or creed or gender or color or economic or social status. I believe that a person's greatest possession, as well as his or her greatest contribution to society, may lie in the ways in which he or she differs from me, rather than in the ways in which we are similar. I shall accept these differences and try to build a useful relationship upon them. I uphold the principles of my organization, recognizing and assuming my responsibility to establish and administer the best possible program and policies for my Board or Commission. I shall learn its programs and objectives, give to it a fair share of my time and personal abilities, and keep a Countywide perspective knowing that, for sound County service, my Board or Commission's work must be coordinated with the total County. I promise to be loyal to my own organization and a good neighbor to other agencies. My attitude shall be one of cooperative open- mindedness and objectivity. In carrying out my assignments, I shall be professional in realizing it is not possible to lay down absolute rules for all situations. I shall be willing to think things through with other Board or Commission members, weighing alternatives and exercising good judgment in choosing among them. )N e � __//y Signature 'G /Share%Eorms /Applications 4,//4 D fe Human Resources Department MEMORANDUM F IE, .E 3 o1;; DATE: February 11, 2013 O! ESr 0F } ��f �Ci4S� TO: Susie Parel - Duranceau, Director of Community Services FROM: Marcia Trylch, Human Resources Office Specialist RE: Completed Background Information on Sarah Skemp The Human Resources Department has completed the required Background Investigations on the requested appointee to the Youth Council and has found that they meet Mohave County's background requirements. With a copy of this letter to the Clerk of Board of Supervisors, I am forwarding the original application. A copy of the application has been attached herewith for your records. C: File • Clerk of the Board MOHAVE CO.UNTY`�APPLICATION f. QUNr APPOINTMENT TO BOARDS OR COMMISSIONS Please return completed application to: MOHAVE COUNTY CLERK OF THE BOARD'S OFFICE 18 700 W. BEALE ST, P.O. BOX 7000, KINGMAN, AZ 86402 -7000 Phone: 928 - 753 -0731, Extension 4731 Fax: 928 - 753 -0732 TDD: 928 - 753 -0726 The.application form must be completed in sufficient detail to allow comprehensive review and evaluation. Issuance or acceptance of this application form does not create an obligation in any manner for Mohave County. In no case shall acceptance of an application constitute assurance of consideration, and an applicant may be required to submit additional application information to be considered for appointment to a Mohave County board or commission. 1. POSITION FOR WHICH YOU ARE INTERESTED IN SERVING ON Check more than one if you wish): 2. Skema Sarah LAST NAME FIRST NAME MI 3. Lake Havasu City AZ 86404 STREET ADDRESS CITY STATE ZIP MAILING ADDRESS (if different from above) CITY STATE ZIP 4. HOME PHONE: WORK / CELL PHONE: 5. MESSAGE CONTACT: N/A NAME ADDRESS PHONE # 6. EMAIL ADDRESS_ 7. Are you a registered voter? Board of Adjustment ❑ NO 8. Do you live in the County Limits? ® YES ❑ NO Board of Health ®YES Building Code Advisory Board Extension Advisory Board Industrial Development Authority Libra — Citizens Advisory Board Merit Commission Parks Advisory Committee Planninq and Zoning Commission Self Insurance Retention/Employee Benefit Trust Public Land Use Committee Workforce Investment Board Transportation Commission Other Please indicate): X Youth Council 2. Skema Sarah LAST NAME FIRST NAME MI 3. Lake Havasu City AZ 86404 STREET ADDRESS CITY STATE ZIP MAILING ADDRESS (if different from above) CITY STATE ZIP 4. HOME PHONE: WORK / CELL PHONE: 5. MESSAGE CONTACT: N/A NAME ADDRESS PHONE # 6. EMAIL ADDRESS_ 7. Are you a registered voter? ®YES ❑ NO 8. Do you live in the County Limits? ® YES ❑ NO 9. Do you live in the city limits? ®YES ❑ NO; If YES, identify which city: Lake Havasu City 10. Are you available for evening meetings? OYES ❑ NO 11. Are you available for early morning meetings? EYES ❑ NO (given ample notice) 12. Are you available for lunch meetings? I EYES ❑ NO (given ample notice) 13. Are there any days of the week you are not available for any meetings? ❑ YES M NO; If YES, identify which day(s) you are not available: 0 MON ❑TUE ❑ WED ❑ THU ❑ FRI 14. If appointed, please indicate which address you wish your mail to be sent: Work/Business Address: ❑ WORK/BUSINESS ® HOME 15. Have you been known to previous schools, employers or references by another name? ❑ YES a NO If yes, please provide name(s) 16 {If you 'possess a valid driver's license, check the class number and complete the following: Commercial Driver's License (CDL): ❑ A ❑ B ❑ C List Special Endorsements K t ' 'Other Driver's License: M D ❑ M MISC.- Please Specify:. Driver's License ? State: AZ 17. Have you ever been convicted of any violation of the law including moving traffic violations? You must answer yes if -:you have any convictions, in any state, no matter how long ago,'whether felony or misdemeanor, even if they have been set aside, vacated, pardoned, expunged, dismissed or appealed, whether or not your civil rights were restored, you successfully completed probation, went to trial, entered a guilty plea or a no contest plea? ❑ YES ®NO If yes, please explain all convictions as accurately and completely as possible. Convictions will be evaluated in relation to the particular appointment to a board or commission for which you are applying for and will not necessarily disqualify you for an appointment (Attach additional sheets as necessary). PLEASE NOTE: Prior to considering an appointment to a Board or Commission, Mohave County will require you to undergo and pass a thorough background investigation for the purpose of having a criminal history review. Any false statement or omission will be considered falsification of your application and grounds for immediate non - consideration of an appointment to a Mohave County Board or Commission. EDUCATION & TRAINING 1&-- ELEMENTARY AND SECONDARY EDUCATION: Did you receive a High School Diploma or G.E.D.? 13 YES ❑ NO 19: COLLEGE AND TRADE SCHOOLS: 20. List appointment - related licenses, registrations, certificates or professional memberships: (Copy must be attached if a requirement of the appointment for which you are applying) DESCRIPTION CREDIT NUMBER STATE ISSUING TYPE OF DEGREE NAME & LOCATION HOURS MAJOR DEGREE AWARDED Sonoma State Univ., Rohnert Park, CA 60 School Counseling M.A. 13 YES ❑ NO Univ. of Wisconsin- Platteville 128 Elementary Education B.S. o YES ❑ NO 20. List appointment - related licenses, registrations, certificates or professional memberships: (Copy must be attached if a requirement of the appointment for which you are applying) DESCRIPTION NUMBER STATE ISSUING EXPIRES Counselor PreK -12 8 -03 -2016 Teacher K -8 10 -27 -2014 21. MILITARY SERVICE: ❑ YES ©NO If "YES ", please complete the following: Branch of Service: Date Entered: Date Separated: _ Are you currently a member of a U.S. Reserve or National Guard unit? ❑ YES ❑ NO If "YES ", list current assignment: 22. EMPLOYMENT HISTORY: Beginning with your current or most recent employer (including volunteer experience), list your employers and volunteer service for the last 10 years of employment/service. Provide complete and accurate addresses of former employers and agencies to which you volunteered. Attach additional sheets as necessary. You may include a resume; however, the employment history section must be fully completed UNLESS YOUR RESUME PROVIDES ALL OF THE INFORMATION REQUESTED BELOW. MAY WE CONTACT YOUR PRESENT EMPLOYER? ® YES ❑ NO A. Company: Lake Havasu Unified School District #1 Phone Number (928)505 -6900 Address /City /State: 2200 Havasupa[ Blvd Lake Havasu City AZ 86403 Start Date: 08/06/2011 End Date: Present Your Title: High School Counselor Duties (be specific): instruction as well as presentations. Reason for Leaving: „Name7of.Supervis6r /Reference Contact: Denise Miner Phone Number: (928)854 -5318 B Company;; North Iowa Area Community College Phone Number.(641)423 -1264 Address /City /State: 500 College Drive --Mason' City Iowa 50401 Start Date: 08/30/2009 End Date: 08/04/11 Your Title: Employment Training Specialist (WIA) Duties (be specific):Assist participants of WIA (three programs: Dislocated Worker Adult and Youth) with career development including interpretation of assessment data: offer intensive services to help participants maintain or improve fob skills, travel throughout seven (7) counties to promote WIA youth program and meet participants in schools residences or public areas- develop individual employment plans; coordinate work experience for youth which included communications with employers, enforcing labor laws, and maintaining record, of the WIA Youth Council. Reason for Leaving: relocated back to Arizona Name of Supervisor /Reference Contact: Angie Konig Phone Number: (641) 422 -1536 C. Company: Lake Havasu Unified School District #1 Phone Number:(928)505 -6900 Address /City /State: 2200 Havasupai Blvd Lake Havasu City AZ 86403 Start Date: 01/07/2003 End Date: 06/10/2009 Your Title: High School Counselor Duties (be specific): Provide personal counseling to students (9th 12th grade) regarding social emotional behavioral or academic development: refer students and families to Reason for Leaving: moved to Iowa Name of Supervisor /Reference Contact: Denise Miner Phone Number: (928)854 -5318 D. Company: Mohave Community College Phone Number:(928)855 -7812 Address /City /State: 1977 Acoma Blvd West Lake Havasu City AZ 86403 Start Date: 09/2004 End Date: 12/2005 Your Title: Academic Counselor Duties (be specific): Seasonal academic advisor who reviewed academic placement tests and advised students of courses to enroll in order to pursue their academic goals. Reason for Leaving: seasonal position Name of Supervisor /Reference Contact: Jann Woods Phone Number: (928) 757 -0803 E. Company: Department of Economic Security Phone Number:(928)854 -0360 Address /City/State: 232 London Bridge Road Lake Havasu City, AZ 86403 (also in Kingman) Start Date: 08/06/1998 End Date: 12/31/2002 Your Title: Child Protective Services Specialist Duties (be specific): Investigated complaints of abuse and submitted documents for legal action attended and tested in court hearings. Reason for Leaving: pursue career as high school counselor Name of Supervisor /Reference Contact: Rodney Lewis (recently retired) Phone Number: (928) 854 -0360 23. Have you been fired, terminated, or requested to resign (instead of termination) from any employment or volunteer position for misconduct or unsatisfactory service in the past ten (10) years? DYES ❑ NO If yes, please identify the name of the employer or agency and explain the circumstances surrounding the severance of your employment or volunteer relationship: 24. List all civil actions in which you were a party, other than divorce proceedings: o NONE Date Location I Nature of action or proceeding I Disposition /Court Action 25. List any other experience, knowledge ;and /or skillp that you feel would especially qualify you for the Boards or Commissions in which you are interested :When'l`.was aneEmploymentTraining Specialist, one of mV tasks was to resurrect the WIA Youth Council which had been dormant for several years: I'contacted those I thought would bring a vast assortment of services and suggestions to enhance services to the local youth. I am currently on the Steering Committee for the COYOTE program. 26. Have you ever or are you now on any public Boards and /or Commissions or Committees? ® YES ❑ NO If YES, please list the Boards /Commissions /Committees, including length of service: BOARD /COMMISSION /COMMITTEE LENGTH OF SERVICE DATES Arizona School Counselors Association 1.5 vears Big BrotherslBi Sisters (Secretary) 2 years School- Improvement Council LHHS 1.5 years 27. In what way do you feel you will benefit the Public by serving on the particular Board(s) or Commission(s) you have selected in Question #1? Asa -high school counselor, I will bring to this Council an unique prospect of what youth are doing /what trends are happening -and will be happening in the future As an advocate for youth I always want to find ways to increase and develop services to our youth making our community stronger. 28. REFERENCES: Give names and addresses of three people, not relatives, who have knowledge of your skills, experience and abilities. NAME 1 • Susan Martin 2. Francine Dropin 3. Robert (Bob) Pai BUSINESS /OCCUPATION ASU Academic Success Speciali Lake Havasu Hish School Media Assistant Lake Havasu High School School Counselor ADDRESS PHONE i READ THEFOLLOWING STATEMENT CAREFULLY AND SIGN Application IS INVALID unless SIGNED BY THE APPLICANT I certify that the facts set forth on this application are true and complete, and I understand any misrepresentation shall be sufficient to remove my application from consideration. Please Initial /Date: -2-0-1-3 I authorize Mohave County and any agent acting on its behalf to conduct an inquiry into any information related to my application, which may include a criminal background check. If selected to a Board or Commission, all personal data (except Social Security Number) will become a matter of public record, subject to public disclosure laws pursuant to ARS § 39 -121. Please Initial /Date: �3s I certify that I understand, if appointed to a Board or Commission, I am subject to Arizona Open Meeting Law pursuant to ARS § 38 -431, and conflict of interest as outlined in ARS § 38 -503, and the requirements of ARS § 38 -201 (D) and (E) requiring compliance with the Federal Military Selective Service Act, 50 U.S.C. § 453, or that I am exempt from the same. Please Initial /Date: '2 - 3- J 3 If selected, I will be provided specific information relevant to the above referenced Arizona Revised Statutes. The process of my selection may include interviews by the Board or Commission that I wish to join, as well as, an interview by the full Board of Supervisors, and an official vote for or against my appointment, in a regularly scheduled Board of Supervisors meeting. Signature (Do not print): '7z Date: L 3-J 3 Bank Application- 02112003.doc A Board or Commission, Member's Ethics Code As a Board or Commission member, I believe that the primary purposes of a Board or Commission are to achieve effective and wise guidance of the County through group thinking and action, to raise the standards of the Board or Commission membership and to improve the level of services to the County that supports it. I realize that mine is a County trust, that I represent all the people and that I have a duty to the County as well as to the Board or Commission. I pledge myself, therefore, to be sensitive to my obligations and relationships in this trusteeship. I subscribe to the code of an ethical person, remembering that ethics refers to what a person. is morally obliged to do or not to do in a given situation. I believe that Board or Commission service can be an expression of democratic citizenship, signifying a willingness to accept County responsibility and the charge to preserve the popular control of American public services. Respecting the dignity and worth of the individual, I shall base my relations with people on their qualities as individuals without distinction as to race or creed, or gender or color or economic or social status. I believe that a person's greatest possession, as well as his or her greatest contribution to society, may lie in the ways in which he or she differs from me, rather than in the ways in which we are similar. I shall accept these differences and try to build a useful relationship upon them. I uphold the principles of my organization, recognizing and assuming my responsibility to establish and administer the best possible program and policies for my Board or Commission. I shall learn its programs and objectives, give to it a fair share of my time and personal abilities, and keep a - Countywide perspective knowing that, for sound County service, my Board or Commission's work must be coordinated with the total County. I promise to be loyal to my own organization and a good neighbor to other agencies. My attitude shall be one of cooperative open- mindedness and' objectivity. In carrying out my assignments, I shall be professional in realizing it is not possible to lay down absolute rules for all situations. I shall be willing to think things through with other Board or Commission members, weighing alternatives and exercising good judgment in choosing among them. __Sarah Skemp Name Signature G /Sham/Forms/Applications 01/30/2013 Date Lake Havasu Unified School District No. 1 -LAKE HAVASU HIGH SCHOOL 2975 S. Palo Verde Blvd., Lake Havasu City, AZ 86403 928.854.5011 fax - 928.854.5499 www.havasu.kl2.az.us Nd. t6. WAVE I. ,our cueer choice! Mohave M Community MCCCollege ;r;,;:i February 4, 2013 *a 7 Subject: Skemp, Letter of Recommendation Local Workforce Investment Board - Mohave LaPaz Youth Council: I am the Career & Technical Education Coordinator for Lake Havasu Unified School District "in Lake Havasu City, Arizona. It is my pleasure to recommend to you Sarah Skemp. Sarah is a Guidance Counselor at Lake Havasu High School and,isvery knowledgeable regarding youth and workplace skills. She has many years of experience working with youth and is networked throughuoul our county to' "assis .ti e efforts of the L -WIB. Sarah is reliable; thorough,and would bean as' egt:,toi Ohe Youth Council team. q3v Sys .. Again, I am pleased to reeomm•a...; end"to you Sarah �Skemp .F5 y ,, Sincerely, t' - Shawna Schneikart, M.Ed. sschneikart@,havasu.kI 2.az.us Career & Technical Education Coordinator LHUSD # 1 Page 1 of 1