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10/8/2020 Revize Online Forms <br />https://moundsviewmn.rja.revize.com/reports/75767 2/2 <br />PRIVACY NOTICE: 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, should you <br />not furnish this information the City may have difficulty determining your suitability for appointment, contacting you regarding your information, and if selected, <br />notifying you of your duties on 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 />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 />Have been elected to the Edison HS Hall of Fame and the USSSA Softball Hall of Fame. I have been named the Butch Nash Assistant <br />Coach of the year award and have received the Cal Stoll Coach of the Year award. I am a 2-time cancer survivor, father of 4 and husband. I <br />have grown roots in this community and I believe can provide an unique perspective the the EDC. <br />What is your reason for wanting to service on this Commission/Committee <br />I would like to continue to be involved in our community and have been in the front lines of the Economic Development of Mounds View <br />since 2006. I would like to continue to work hard to bring about positive change for this community. <br />Please attach additional information if desired: <br />No file chosenChoose File <br />Optional <br />Applicant Signature <br />Jeff Moritko <br />Date <br />10/08/2020 <br />Format: MM/DD/YYYY