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01-06-2020 CCsp
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01-06-2020 CCsp
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1/3/2020 12:34:41 PM
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MV City Council
City Council Document Type
City Council Packets
Date
1/6/2020
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MOUNDS VIEW <br />2401 Mounds View Boulevard ` Mounds View MN 55112-1499 <br />(763) 717-4000 Fax (763) 717-4019 <br />barb. beneschtc'z ci.mounds-view m us <br />To be completed by Mounds View: <br />Date Application Received: <br />❑ NEW APPLICATION (never served) <br />❑ RENEWAL APPLICATION <br />❑ APPROVED Date <br />Term Expires: <br />APPLICATION FOR ADVISORY BOARD/COMMITTEE/COMMISSION <br />�Applicant Information <br />Name: <br />Address: <br />v� t ) Phone #1: 61a _ S"97- 737B <br />City: /�i� //Dundls / U State: �N _ Zip: Phone #2 <br />�nw <br />Years at this address: a Years you have lied in Mounds View: <br />Email: n <br />• •74- <br />AILP• • • • • <br />❑ Planning Commission (meets the 1' and 3r1 <br />© Economic Development Commission Wednesday of each months at 7:00 pm) <br />(meets 3rd Friday of each month at 7:30 am) Police Civil Service Commission <br />Parks, Recreation & Forestry Commission (meets on an "as needed" basis) <br />(meets the 41' Thursday of each month at 6:00 pm) Comprehensive Plan Taskforce <br />Experience• Qualifications <br />Skills and Interests: <br />EmploWnent, Occupation or Other Relevant Experience: <br />e5� T <br />Memberships, Accomplishment or Other Qualifications: <br />What is your main reason for wanting to serve on this Commission/Committee: <br />-- <br />TENNESSEN WARNING! The information provided by you on this application will be used to determine your suitability for appointment to an advisory <br />commission. Participation as an advisory commission member is strictly voluntary and you are not required by law to provide this information. However, <br />should you not furnish this information the City may have difficulty determining your suitability for appointment, contacting you regarding your information, <br />and if selected, with your duties on the advisory commission. Under Minnesota State Statute 13.601, subd.3, the following information is considered <br />public information before appointment: name, city of residence, education and training, employment history, volunteer work, awards and honors, prior <br />government service, veteran status. Once an individual is appointed, the following additional items of data are considered public: residential address, <br />telephone number, email address. I have read and understand the Tennessean Warning and certify that the statements in this application are true and <br />correct to the best of my knowledge: <br />Applicant Signature: <br />Date: <br />uu, response LU diiy ui the above Inquiries may be continued on the back of this form and you may attach other information <br />that you would like the City Council to consider. <br />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, <br />ethnicity, gender, age or physical abilities. <br />
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