Submit Date: Nov 09, 2019

First Name Middle Initial Last Name

Home Address Suite or Apt

City State Postal Code

Email Address

Primary Phone Alternate Phone

Employer Job Title Occupation

Washington County, OR Boards & Commissions

Application Form

Profile

Alternate Email Address

Are you employed in Washington County?

Yes No

If you live in Washington County, in what district do you reside in? *

District 3

District look-up here

What days and times are you available to meet?

Tu-Fr; days

Please list the Washington County Boards that you are currently serving on, or havepreviously served on (include the dates of your term).

Served as the City of Tigard representative on the Aging and Veterans Services Advisory Council in 2009.

Interests & Experiences

Which Boards would you like to apply for?

Aging and Veteran Services Advisory Council: Submitted

Chrsitine "Chris" L Wiley

Sherwood OR 97140

Retired

Chrsitine "Chris" L Wiley Page 1 of 4

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Question applies to Aging and Veteran Services Advisory Council

An additional short Supplementary Application is needed for this Board. Someone will contactyou about this soon. If you have any questions, please call (503) 846-3081.

If you selected multiple Boards, which is your preferred choice?

N/A

How did you hear about the Board/s you are applying for? *

County Website

Why are you interested in serving on the Board/s you are applying for?

I am awaiting appointment to the newly established Senior Advisory Committee for Sherwood Oregon andbelieve participating on the County board will be advantageous for my understanding of the issues andgood continuity for the local city committee.

Are you interested in other volunteer opportunities?

Yes No

If you are interested in other opportunities, may we contact you?

Yes No

What education, work experience, volunteer experience or life experience do you bring?

I have thousands of hours of volunteer experience and committee experience. I am a retired disabled 20-year Air Force veteran and subsequently worked in city government for several years after retiring fromthe Air Force. I also was the caregiver for both my parents, who lived in King City and an aunt who lived indowntown Portland. In that capacity I had experience with the Veterans Administration for my father's careand with hospice for my mother and aunt. I presently have a brother in the V.A. health care system whomI look after.

Describe your understanding of the concerns and issues facing the Board/s you wish toserve on.

Needs assessment, responsible use of resources, assurances that resources are not wasted byduplicating efforts through similar agencies, communicating what assistance is available for seniors andveterans, continually educating ourselves as the dynamics change such as the current decrease of thepopulation that grew up during the depression and World War II and a transition to a focus on the nextgeneration, the "boomers".

List any potential conflict of interest between your public and private service that mightresult from your appointment to a Board/s you are applying for.

I don't foresee any.

References

Resume_Wiley_2019.doc

Chrsitine "Chris" L Wiley Page 2 of 4

Full name of Reference #1

Sylvia Murphy

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

Sue Engels

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement

By submitting this form, I am affirming that all the information is true to the best of myknowledge and that I understand that any misstatement of fact or misrepresentation ofcredential may result in this application being disqualified from further consideration or,subsequent to my appointment to a board/committee/commission, may result in dismissal.Also, information I provide on this application may become part of the public record.

I Agree

Demographics

Chrsitine "Chris" L Wiley Page 3 of 4

Date of Birth

Ethnicity *

None Selected

Gender *

None Selected

Sexual Orientation *

None Selected

Chrsitine "Chris" L Wiley Page 4 of 4

Submit Date: Jul 30, 2019

First Name Middle Initial Last Name

Home Address Suite or Apt

City State Postal Code

Email Address

Primary Phone Alternate Phone

Employer Job Title Occupation

Washington County, OR Boards & Commissions

Application Form

Profile

Alternate Email Address

Are you employed in Washington County?

Yes No

If you live in Washington County, in what district do you reside in? *

District 1

District look-up here

What days and times are you available to meet?

Any.

Please list the Washington County Boards that you are currently serving on, or havepreviously served on (include the dates of your term).

Interests & Experiences

Which Boards would you like to apply for?

Aging and Veteran Services Advisory Council: Submitted

Erin Miller

beaverton OR 97007

Metro West AmbulanceVice President of BusinessDevelopment Medical Transportation

Erin Miller Page 1 of 3

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Question applies to Aging and Veteran Services Advisory Council

An additional short Supplementary Application is needed for this Board. Someone will contactyou about this soon. If you have any questions, please call (503) 846-3081.

If you selected multiple Boards, which is your preferred choice?

How did you hear about the Board/s you are applying for? *

County Website

Why are you interested in serving on the Board/s you are applying for?

I would like the opportunity to assist in the conversations that impact seniors and veterans in WashingtonCounty. I attended a meeting last week and was very impressed! I think I have a background andknowledge that would be helpful in solving problems faced by seniors and veterans.

Are you interested in other volunteer opportunities?

Yes No

If you are interested in other opportunities, may we contact you?

Yes No

What education, work experience, volunteer experience or life experience do you bring?

I have a BS In Communications. I've worked in aging services my entire career, starting with Senator RonWyden. I've worked in medical transportation for almost 30 years. I've been on the Legacy Meridian ParkHospital Board and am now a member of the Portland Providence Foundation.

Describe your understanding of the concerns and issues facing the Board/s you wish toserve on.

Because my career has focused on senior issues - I have a unique understanding of the challenges facingthem today. Additionally, I have 3 sets of parents all in their 80's, one is a veteran, so I'm familiar with theirchallenges.

List any potential conflict of interest between your public and private service that mightresult from your appointment to a Board/s you are applying for.

I cannot think of any conflicts of interest.

References

Full name of Reference #1

JD Fuiten

Erin_Miller_07-16-2019.pdf

Erin Miller Page 2 of 3

Date of Birth

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

Sarah Taft

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement

By submitting this form, I am affirming that all the information is true to the best of myknowledge and that I understand that any misstatement of fact or misrepresentation ofcredential may result in this application being disqualified from further consideration or,subsequent to my appointment to a board/committee/commission, may result in dismissal.Also, information I provide on this application may become part of the public record.

I Agree

Demographics

Ethnicity *

None Selected

Gender *

None Selected

Sexual Orientation *

None Selected

Erin Miller Page 3 of 3

Submit Date: Sep 11, 2019

First Name Middle Initial Last Name

Home Address Suite or Apt

City State Postal Code

Email Address

Primary Phone Alternate Phone

Employer Job Title Occupation

Washington County, OR Boards & Commissions

Application Form

Profile

Alternate Email Address

Are you employed in Washington County?

Yes No

If you live in Washington County, in what district do you reside in? *

District 2

District look-up here

What days and times are you available to meet?

As needed.

Please list the Washington County Boards that you are currently serving on, or havepreviously served on (include the dates of your term).

I have not served on any Washington County boards, but have served on boards and advisory committeesin other locations.

Interests & Experiences

Which Boards would you like to apply for?

Aging and Veteran Services Advisory Council: Appointed

Gary S O'Neal

Portland OR 97225

Retired NA NA

Gary S O'Neal Page 1 of 4

Question applies to Aging and Veteran Services Advisory Council

An additional short Supplementary Application is needed for this Board. Someone will contactyou about this soon. If you have any questions, please call (503) 846-3081.

If you selected multiple Boards, which is your preferred choice?

NA

How did you hear about the Board/s you are applying for? *

County Website

Why are you interested in serving on the Board/s you are applying for?

As explained below, I have a great deal of experience in aging, anti-poverty and volunteer programs. I'malso a veteran and speak Spanish. Since moving to Portland from southern Oregon, I have more timeavailable to volunteer and would be willing to spend additional time working on sub-committees ifnecessary.

Are you interested in other volunteer opportunities?

Yes No

If you are interested in other opportunities, may we contact you?

Yes No

What education, work experience, volunteer experience or life experience do you bring?

Officer, USMCR; Peace Corps Volunteer, Guatemala; Peace Corps Director, Costa Rica; State Director,Commission for National and Community Service, Utah and Puerto Rico; Executive Director, Sunny WolfCRT, a social and economic development 501-C3 corporation in southern Oregon; BS, BusinessAdministration, Univ. of California, Berkeley; MA, International Studies, Univ. of Oregon, Eugene. I haveextensive experience funding and monitoring aging and anti-poverty programs, as well as conductingboard training and recruiting volunteers. I'm also a landlord - a good one, not a slum lord -and am veryknowledgeable about landlord/tenant issues in Oregon.

Describe your understanding of the concerns and issues facing the Board/s you wish toserve on.

I have not researched the specific issues currently facing the Aging and Veteran Services AdvisoryCouncil, but would expect to be brought up to date as a new member. As a federal employee, I developedand funded Americorps and VISTA programs, Retired Senior Volunteer programs, Foster Grandparentprograms, Senior Companion programs, and other related grants and contracts. As Sunny Wolf CRTDirector, I worked with people suffering severe unemployment and substance abuse problems in one ofthe lowest income rural areas of Oregon. On a personal level I have been a Representative Payee andAARP Tax Aide Volunteer for people who need various types of financial assistance. I've also been aNCHEC Certified Foreclosure Intervention Counselor and worked with defaulting homeowners during thepast financial downturn to help them remain in their homes.

List any potential conflict of interest between your public and private service that mightresult from your appointment to a Board/s you are applying for.

None

Gary S O'Neal Page 2 of 4

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References

Full name of Reference #1

Pamela Hurlburt

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

Neil Thuresson

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement

By submitting this form, I am affirming that all the information is true to the best of myknowledge and that I understand that any misstatement of fact or misrepresentation ofcredential may result in this application being disqualified from further consideration or,subsequent to my appointment to a board/committee/commission, may result in dismissal.Also, information I provide on this application may become part of the public record.

I Agree

Demographics

CCF09102019.pdf

Gary S O'Neal Page 3 of 4

Date of Birth

Ethnicity *

None Selected

Gender *

None Selected

Sexual Orientation *

None Selected

Gary S O'Neal Page 4 of 4

Submit Date: Feb 18, 2020

First Name Middle Initial Last Name

Home Address Suite or Apt

City State Postal Code

Email Address

Primary Phone Alternate Phone

Employer Job Title Occupation

Washington County, OR Boards & Commissions

Application Form

Profile

Alternate Email Address

Are you employed in Washington County?

Yes No

If you live in Washington County, in what district do you reside in? *

District 2

District look-up here

What days and times are you available to meet?

Flexible due to the ability to adjust work schedules

Please list the Washington County Boards that you are currently serving on, or havepreviously served on (include the dates of your term).

I have not served

Interests & Experiences

Which Boards would you like to apply for?

Aging and Veteran Services Advisory Council: Submitted

Jessica A Cassidy

Beaverton OR 97005

Russellville Park Memory Care Manager

Assisted LivingAdministrator/LicensedPractical Nurse

Jessica A Cassidy Page 1 of 4

Question applies to Aging and Veteran Services Advisory Council

An additional short Supplementary Application is needed for this Board. Someone will contactyou about this soon. If you have any questions, please call (503) 846-3081.

If you selected multiple Boards, which is your preferred choice?

Aging and Veterans Services

How did you hear about the Board/s you are applying for? *

County Website

Why are you interested in serving on the Board/s you are applying for?

As a Nurse and Healthcare Administrator I have worked with the Elderly for over a decade, even caringfor my grandmother in my late teens and 20s. My work, for over a decade, has centered around improvingthe lives of seniors in the community settings I’ve worked for. I was a CNA, then and LPN and now I’m inAdministration. My goal now is to work within government structures to effect the lives of seniors andveterans in a positive, sustainable way.

Are you interested in other volunteer opportunities?

Yes No

If you are interested in other opportunities, may we contact you?

Yes No

What education, work experience, volunteer experience or life experience do you bring?

From the age of 19-26 I cared for my ailing grandmother who suffered with dementia and other healthproblems. In 2009 I became a CNA and in 2011 a Licensed Practical Nurse. I’ve worked with the elderlythroughout my 10 years of experience in Long Term Care, Memory Carr, Assisted Living, Sub-AcuteCare, and Home Care Settings including time as a travel nurse working in MO, MN, NE, HI, WA and OR.In 2018-19 I worked in management for a local small business in Aloha OR, a home care companyserving seniors and people with disabilities. I worked with Washington County Casemanagers as well asVeterans Services, local hospitals, etc... to help our local seniors live their most independent and best lifepossible. In late 2019 I accepted a position with Leisure Care at Russellville Park in Portland where Icurrently manage the Memory Care Community. I received my Certification in ALF/RCF Administration inDec 2019 and I’m waiting to sit for my board exam. Leisure Care operates multiple communities in theWashington County area.

Describe your understanding of the concerns and issues facing the Board/s you wish toserve on.

Concerns such as funding for and availability of Veterans services, Mental health needs of the senior andveteran community, and support services for Medicaid recipients are all issues I’ve dealt with from abusiness perspective. Funding, Budgeting, and Providing these services as well as others are new to mefrom a board/commission stand point, but I am open to listening, learning, and creating/applying creativesolutions to the concerns facing the board

Jessica A Cassidy Page 2 of 4

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List any potential conflict of interest between your public and private service that mightresult from your appointment to a Board/s you are applying for.

There is no conflict. My current position is with a facility in Portland and neither the company I work for norany relationships I am aware of conflict with my work with Washington County.

References

Full name of Reference #1

Anne Grisbrink

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

Dane Kjornes

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement

By submitting this form, I am affirming that all the information is true to the best of myknowledge and that I understand that any misstatement of fact or misrepresentation ofcredential may result in this application being disqualified from further consideration or,subsequent to my appointment to a board/committee/commission, may result in dismissal.Also, information I provide on this application may become part of the public record.

I Agree

Jessica-Cassidy.pdf

Jessica A Cassidy Page 3 of 4

Date of Birth

Demographics

Ethnicity *

None Selected

Gender *

None Selected

Sexual Orientation *

None Selected

Jessica A Cassidy Page 4 of 4

Submit Date: Oct 12, 2019

First Name Middle Initial Last Name

Home Address Suite or Apt

City State Postal Code

Email Address

Primary Phone Alternate Phone

Employer Job Title Occupation

Washington County, OR Boards & Commissions

Application Form

Profile

Alternate Email Address

Are you employed in Washington County?

Yes No

If you live in Washington County, in what district do you reside in? *

District 4

District look-up here

What days and times are you available to meet?

Flexible

Please list the Washington County Boards that you are currently serving on, or havepreviously served on (include the dates of your term).

None

Interests & Experiences

Which Boards would you like to apply for?

Aging and Veteran Services Advisory Council: Submitted

Robert A. Newton

Hillsboro OR 97123

Self Attorney and Author

Robert A. Newton Page 1 of 3

Upload a Resume

Question applies to Aging and Veteran Services Advisory Council

An additional short Supplementary Application is needed for this Board. Someone will contactyou about this soon. If you have any questions, please call (503) 846-3081.

If you selected multiple Boards, which is your preferred choice?

How did you hear about the Board/s you are applying for? *

County Website

Why are you interested in serving on the Board/s you are applying for?

I have lived in Washington County for over 30 years and would like to make a meaningful contribution tothe community, particularly in relation to veterans and the elderly.

Are you interested in other volunteer opportunities?

Yes No

If you are interested in other opportunities, may we contact you?

Yes No

What education, work experience, volunteer experience or life experience do you bring?

I am an attorney and writer with comprehensive legal experience. I have a bachelors degree as well as ajuris doctor degree. I am a veteran of the U.S. Army and over the age of 65. While in law school, I was anassistant to the veterans representative for two years under the work studies program. I support veteransorganizations and have provided financial and emotional support to veterans with PTSD.

Describe your understanding of the concerns and issues facing the Board/s you wish toserve on.

Veterans and the elderly face unique challenges, primarily in relation to health care and housing. It is myunderstanding that the Aging and Veterans Service Advisory Counsel would probably be focusing onoutreach, education and funding issues.

List any potential conflict of interest between your public and private service that mightresult from your appointment to a Board/s you are applying for.

None.

References

Full name of Reference #1

Richard Adams

RESUME-ORE-DOC.docx

Robert A. Newton Page 2 of 3

Date of Birth

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

503-347-3773

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement

By submitting this form, I am affirming that all the information is true to the best of myknowledge and that I understand that any misstatement of fact or misrepresentation ofcredential may result in this application being disqualified from further consideration or,subsequent to my appointment to a board/committee/commission, may result in dismissal.Also, information I provide on this application may become part of the public record.

I Agree

Demographics

Ethnicity *

None Selected

Gender *

None Selected

Sexual Orientation *

None Selected

Robert A. Newton Page 3 of 3

Submit Date: Jan 21, 2020

First Name Middle Initial Last Name

Home Address Suite or Apt

City State Postal Code

Email Address

Primary Phone Alternate Phone

Employer Job Title Occupation

Washington County, OR Boards & Commissions

Application Form

Profile

Alternate Email Address

Are you employed in Washington County?

Yes No

If you live in Washington County, in what district do you reside in? *

District 1

District look-up here

What days and times are you available to meet?

Any time

Please list the Washington County Boards that you are currently serving on, or havepreviously served on (include the dates of your term).

Interests & Experiences

Which Boards would you like to apply for?

Aging and Veteran Services Advisory Council: Submitted

Yaroslav Kucheryavenko

Aloha, OR OR 97006

Yaroslav Kucheryavenko Page 1 of 3

Upload a Resume

Question applies to Aging and Veteran Services Advisory Council

An additional short Supplementary Application is needed for this Board. Someone will contactyou about this soon. If you have any questions, please call (503) 846-3081.

If you selected multiple Boards, which is your preferred choice?

How did you hear about the Board/s you are applying for? *

Current Board Member

Why are you interested in serving on the Board/s you are applying for?

I am the president of the Russian-speaking club "Faithful Friends" in Beaverton which is a branch of theRussian-American Public Center of the North-West (in our club there are people of 16 nationalities fromthe former USSR). About 80 percent of our club members are older people and we constantly contact theservices that provide us with assistance. Unfortunately, there are no Russian speakers in the board.

Are you interested in other volunteer opportunities?

Yes No

If you are interested in other opportunities, may we contact you?

Yes No

What education, work experience, volunteer experience or life experience do you bring?

I have an engineering degree from the University of Ukraine (Kharkiv), and received the specialty of anCNC programmer from Portland Community College. I worked as a technician at the Maxim factory inBeaverton. Now a pensioner and the president of the Russian-speaking club "Faithful Friends" inBeaverton

Describe your understanding of the concerns and issues facing the Board/s you wish toserve on.

I want to make social services better, help older immigrants better understand social services and feel thatthe United States is their best place to live.

List any potential conflict of interest between your public and private service that mightresult from your appointment to a Board/s you are applying for.

I think I do not have such conflicts.

References

Full name of Reference #1

Kum Lam

Yaroslav Kucheryavenko Page 2 of 3

Date of Birth

Phone number of Reference #1

Email of Reference #1

Full name of Reference #2

Ramzan Magomedov

Phone number of Reference #2

Email of Reference #2

Acknowledgment

Please Agree with the Following Statement

By submitting this form, I am affirming that all the information is true to the best of myknowledge and that I understand that any misstatement of fact or misrepresentation ofcredential may result in this application being disqualified from further consideration or,subsequent to my appointment to a board/committee/commission, may result in dismissal.Also, information I provide on this application may become part of the public record.

I Agree

Demographics

Ethnicity *

None Selected

Gender *

None Selected

Sexual Orientation *

None Selected

Yaroslav Kucheryavenko Page 3 of 3