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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
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