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ATTACHMENT 2

DWD Issuance14-2014

Local Workforce Development Board MembershipCertification or Recertification Form

Local Workforce Development Board: ___NEMO Workforce Development Board______

Attach more forms as needed

Appointee’s
Name & Title / Member
Category* / Nominating
Organization / Appointee’s Company or Organization,
Mailing address, phone #,
fax # and email address / FEIN ** for Business Nominees Only / Member Being Replaced (if applicable)
Dennis Gill, Owner / Business / Mark Twain Lake Chamber of Commerce / Timber Ridge Resort
22764 Joanna Drive
Perry, MO 63462
Phone: 573-565-3135
Fax: 573-565-3901
Email:
Kami Mohn, Manager of Economic Development &
Member Services / Business / Hannibal Area Chamber of Commerce / Northeast Missouri Electric Power Cooperative
PO Box 191, 3705 Business 61
Palmyra, MO 63461
Phone: 573-769-8215
Fax: 573-769-4358
Email: / Gordon Ipson
Darren Arnsmeyer, Manager / Business / The Greater Montgomery County Economic Development Council / New Florence Wood Products
49 Stave Mill Road
New Florence, MO 63363
Phone: 573-252-2517
Fax: 573-252-2516
Email:
Pat Poepping, Owner/Operator / Business / Hannibal Area Chamber of Commerce / Poepping Stone Bach & Associates, Inc.
100 South 54th Street
Quincy, IL 62305
Phone: 217-223-4605
Fax: 217-223-1546
Email:
Diane Noah, Executive Director / Business / HomeCare of Mid-Missouri / HomeCare of Mid-Missouri
102 W Reed Street
Moberly, Mo 65270
Phone: 660-263-1517
Fax: 660-263-8033
Email:
Annette Sweet, Customer Service Advisor / Business / Kirksville Area Chamber of Commerce / Ameren Missouri
204 W Cottonwood
Kirksville, MO 63501
Phone: 660-785-2740
Fax: 660-785-2710
Email:
Dan Putrah, Executive Vice President & Senior Loan Officer / Business / Paris Area Chamber of Commerce / Paris National Bank
118 N Main Street
Paris, MO 65275
Phone: 660-327-4184
Fax: 660-327-5909
Email:
Vincil M. Wilt DVM, Owner / Business / Paris Area Chamber of Commerce / Paris Veterinary Clinic, INC.
25010 Business Hwy 24
Paris, MO 65275
Phone: 660-327-5121
Fax: 660-327-5168
Email:
Steve Sellenriek, Vice President / Business / Montgomery City Area Chamber of Commerce / Sellenriek Construction, Inc.
313 North Gladstone
PO Box 237
Jonesburg, MO 63351
Phone: 636-488-3396
Fax: 636-488-3374
Email:
Corey Mehaffy, Owner / Business / Moberly Area Chamber of Commerce / GSG Growth Services Group, LLC
809 Fox Run
Moberly, MO 65270
(660)353-1726
Email:
Christopher Brokaw, Branch Manager / Business / Pike County Development Authority / U.S. Bank
317 W Main St
Bowling Green, MO 63334
573-324-2281
Email:
Carolyn Chrisman, Director of Economic Development / Economic Dev. / Kirksville Regional Economic Development Inc. (K-REDI) / K-REDI
315 S. Franklin, PO Box 783
Kirksville, MO 63501
Phone: 660-665-2003
Fax: 660-785-2530
Email:
Jim Kolve, Coordinator for Missouri AFL-CIO Dislocated Worker Program, Communication Workers of America (CWA) / Labor -Labor/Apprenticeship/Employees-Workforce / Missouri AFL-CIO / Missouri AFL-CIO
2446 Charente
Saint Louis, MO 63043
Phone: 314-991-1944
Fax: 314-991-1944
Email:
Steve Garner, Business Manager / Labor-Labor/Apprenticeship/Employees-Workforce / Missouri AFL-CIO / Pipefitters, #562
PO Box 735
Fulton, MO 65251
Phone: 573-592-0201
Fax:
Email:
Russell (Butch) Landis, Instructor / Apprenticeship - Labor/Apprenticeship/Employees-Workforce / Missouri AFL-CIO / Operating Engineers Local 513 Training
75 Hwy F
Silex, MO 63377
Office: 573-485-2200 ext. 32
Personal Cell: 573-473-0923
Email: and
Janice Robinson, Deputy Director of Community Service Programs / CBO-Labor/Apprenticeship/Employees-Workforce / North East Community Action Corporation / NECAC
16 North Court, PO Box 470
Bowling Green, MO 63334-0470
Phone: 573-324-6633
Fax: 573-324-2132
Email:
Mark Chambers, Articulation Specialist & CTE Programs / Higher Education / Moberly Area Community College / Moberly Area Community College
101 College Avenue
Moberly, MO 65270
Phone: 660-263-4110
Fax: 660-263-7563
Email:
Ann McCauley, AEL Director / AEL / MO Department of Elementary & Secondary Education Office of Adult Education & Literacy / Moberly Area Community College
101 College Avenue
Moberly, MO 65270
Phone: 660-263-4100 ext. 11307
Fax: 660-269-4997
Email:
Clinton Flowers, Manager of Planning and Research DED / Wagner Peyser (DWD) / Division of Workforce Development / Division of Workforce Development
421 East Dunklin Street
Jefferson City, MO 65101
Phone: 573-526-8261
Fax:
Email:
Amy Bowen, District Supervisor / Vocational Rehabilitation / Department of Elementary and Secondary Education / Division of Vocational Rehabilitation
112 Jaycee Drive
Hannibal, MO 63401
Phone: 573-248-2410
Fax: 573-248-2409
Email: / Jo Moncrief
Lynn Wehmeier, Program Development Specialist / TANF/MWA / Family Support Division / Family Support Division
146 Rodeo Drive
Camdenton, MO 65020
Phone: 573-346-3363
Fax: 573-346-0382
Email:

*Categories include Business,Small Business,Labor/Apprenticeship/Employees-Workforce, AEL, VR, Wagner/Peyser (DWD), Higher Education, Economic Development, TANF/MWA, or other (state name).

**Federal Employer Identification Number issued by the Internal Revenue Service for the business being represented by the nominee. (Attach additional pages as needed.)

ATTESTATION

I, ____Stanley Pickens____, the undersigned Chief Local Elected Official (CLEO) or CLEO Consortium Chair (as applicable) of the _Northeast Missouri__ Workforce Development Region, do hereby state that the information provided within this Local Workforce Development Board certification application is complete and accurate to the best of my knowledge. I also certify that all applicable provisions of the Workforce Innovation and Opportunity Act and any additional requirements by the state of Missouri have been followed in the selection process of the appointee(s) listed above.

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