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Memberships, Accomplishments or Other Qualifications What is your reason for wanting to service on this Commission/Committee ei43* -fs,16611u- Please attach additional information if desired: Choose File No file chosen Optional i PRIVACY NOTICE: The information provided by you on this application will be used to determine your suitability for appointment to an advisory commission. Participation as an advisory commission member is strictly voluntary and you are not required by law to provide this information. However, should you not furnish this information the City may have difficulty determining your suitability for appointment, contacting you regarding your information, and if selected, notifying you of your duties on the advisory commission. Under Minnesota State Statute 13.601, subd.3, the following information is considered public information before appointment: name, city of residence, education and training, employment history, volunteer work, awards and honors, prior government service, veteran status. Once an individual is appointed, the following additional items of data are considered public: residential address, telephone number, email address. I have read and understand the Tennessean Warning and certify that the statements in this application are true and correct to the best of my knowledge: Appli t 5ignat e Date M M/DDJYYYY Format MM/OD/YYYY ta(12(2/ The City of Mounds View is committed to the policy that all persons shall hove access to its programs, facilities and employment without regard for race, ethnicity, gender, age or physical abilities.