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101712020 Revize Online Forms <br />sa <br />Please attach additional information if desired: <br />Choose File No file chosen / <br />Optional l 3 <br />PRIVACY NOTICE: The information provided by you on this application will he used to determine your suitability for appointment to an advisory <br />commission. Participation as an advisory commission member is stricgy 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 fur appointment, contacting you regarding your information, and Ir selected. <br />no*irg you of your duties on the advisory commission. Under Minnesota State Statute 13.601. suhd,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, pnor 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/DDIYYYY <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:l/moundsviewmrLda.fevize-mm)reportsl75539 212 <br />