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Motes VIEW 2401 Mounds View Boulevard * Mounds View MN 55112-1499 (763) 717-4000 * Fax (763) 717-4019 barb, benesch @jgj.mounds-view. mn.us www.ci.rnounds-view.mn.us To be completed by Mounds View Date Application Received: I i A 0 NEW APPLICATION (never served) ❑ RENEWAL APPLICATION ❑ APPROVED Date Term Expires: APPLICATION FOR ADVISORY BOARD/COMMITTEE/COMMISSION Applicant • • Name:Murwo S Mohamed Address: 2657 Mounds View Blvd Apt 203 Phone #1: 651-434-3568 City: Mounds View State: MN zip: 55112 Phone #2 Years at this address: 5 Years Ye-ars- you have lived in Mounds View: 5 Years Email: Planning Commission (meets the 1" and 3rd Economic Development CommissionWednesday of each months at 7:00 pm) ( eats 3rd Friday of each month at 7:30 am) 7F]Police Civil Service Commission arks, Recreation & Forestry Commission (meets on an "as needed" basis) (meets the 41h Thursday of each month at 6:00 pm) Comprehensive Plan Taskforce Experience and Qualifications Skills and Interests: I have Worked with Somali Community In Minnesota , I have Worked Minneapolis Public School, as Tutoring middel school. Employment, occupation or Other Relevant Experience: Minneapolis Community and Technical College. Metropolitan State University St Paul Memberships, Accomplishment or Other Qualifications: N/A What is your main reason for wanting to serve on this Commission/Committee: The Reason i am wanting to serve on this commission/ committee is that i want to engage with the community and help the people of my district. Also, i want to be a role model for the many immigrants who live the city of Mounds View for being active as citizens. TENNESSEN WARNING: The information provided by you on this application will be used to determine your suitability for appointment to an advisory commission. Participation as an advisory commission member is strictly voluntary and you are not required by law to provide this information. However. should you not fumish this information the City may have difficulty determining your suitability for appointment, contacting you regarding your information, and if selected, with your duties on the advisory commission. Under Minnesota State Statute 13.601, subd.3, the following information is considered public information before appointment: name, city of residence, education and training, employment history, volunteer work, awards and honors, prior government service, veteran status. Once an individual is appointed, the following additional items of data are considered public: residential address, telephone number, email address. 1 have read and understand the Tennessean Warning and certify that the statements in this application are true and correct to the best of my knowledge; Applicant Signature: Murwo Mohamed Date: 11/07/219 Your response to any of the above inquiries may be continued on the back of this form and you may attach other information that you would like the City Council to consider. The City of Mounds View is committed to the policy that all persons shall have access to its programs, facilities and employment without regard for race, ethnicity, gender, age or physical abilities.