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I U7I2020 Revize Online Forms <br />Please attach additional information if desired: <br />Choose File i No file chosen <br />Optional <br />PRIVACY NOTICE: The information provided by you on this application will be used to determine your suitability for appo intment to an advisory <br />commission. Participation as an adWsory commission member is strictly voluntary and you are not required by law to provide thia information. However, should you <br />not fumish this Information the City may have dfcuity datermining your suitability for appointment, contacting you regarding your information, and if selected, <br />notifying you of your dulies an the advisory commission, Under Minnesota State Statute 13,601. subd.3, the following information is considered public information <br />before appointment: name, city of residence, education and training, employment history, volunteer work, awards and honors, prior government service, veteran <br />status. Once an individual is appointed, the following additional items of data are considered public: residential address, telephone number, email address. I have <br />read and understand the Tennessean Warning and certify that the statements in this application are true and correct to the best of my knowledge: <br />Applicant Signature <br />Kris lilleml <br />Date <br />10/07/2020 <br />Format: MM/DD/YYYY <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 <br />for race, ethnicity, gender, age or physical abilities. <br />https:/Imoundaviewmn.da.revize.com/reparisn5539 2/2 <br />