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10/28/2020 Revize Online Forms <br />https://moundsviewmn.rja.revize.com/reports/78713 2/2 <br />PRIVACY NOTICE: The information provided by you on this application will be used to determine your suitability for appointment to an <br />advisor y commission. Participation as an advisor y commission member is strictly voluntar y and you are not required by law to provide this <br />information. However, should you not furnish this information the City may have difficulty determining your suitability for appointment, <br />contacting you regarding your information, and if selected, notifying you of your duties on the advisor y commission. Under Minnesota <br />State Statute 13.601, subd.3, the following information is considered public information before appointment: name, city of residence, <br />education and training, employment histor y, volunteer work , awards and honors, prior government ser vice, veteran status. Once an <br />individual is appointed, the following additional items of data are considered public: residential address, telephone number, email address. I <br />have read and understand the Tennessean Warning and cer tify that the statements in this application are true and correct to the best of my <br />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 for <br />race, ethnicity, gender, age or physical abilities. <br />What is your reason for wanting to ser vice on this Commission/Committee <br />I am very grateful for the excellent quality of life Mounds View has provide my family. I hope to give something back by using my experience <br />as a commissioner and my professional experience to serve as an engaged, informed, and committed member of the Planning Commission. <br />Please attach additional information if desired: <br />No file chosenChoose File <br />Optional <br />Applicant Signature <br />Farmer <br />Date <br />10/27/2020 <br />Format: MM/DD/YYYY