Application for Committee, Board, or Commission

1. The Minnesota Government Data Practices Act (Minnesota Statutes Chapter 13) governs the City’s use of the
   information contained in this application. Some of the information sought in this application is private data under the Act. The requested information will be used by the appointing authority to carryout the City’s official appointment responsibilities. You are not required to provide any information. However, failure to answer the application questions may cause the appointing authority to reject your application. The majority of items contained in this application are public, including name, address, employment, skills, training and experience, and are therefore available to anyone requesting it. The remaining items on the application form are classified as private. The private data is available only to you and to other persons in the City who, because of work assignments, reasonably require access to the information.

2. Contact Information

3. First Name*

4. Last Name

5. Address*

6. City*

7. State*

8. Zip Code*

9. Home Phone*

10. Cell Phone

11. Work Phone

12. Fax

13. Email Address*

14. Personal Information

15. Planning District Council*
    -- Select One --District 1 - Battle Creek / HighwoodDistrict 2 - The Greater East SideDistrict 3 - West Side Citizens Organization District 4 - Dayton’s Bluff District 4 Community CouncilDistrict 5 - Payne-Phalen District Five Planning Council District 6 - District 6 Planning CouncilDistrict 7 - District 7 Planning Council District 8 - Summit-University Planning CouncilRamsey Hill Association - The Ramsey Hill AssociationDistrict 9 - Fort Road / West Seventh FederationDistrict 10 - Como ParkDistrict 11 - Hamline-MidwayDistrict 12 - St. Anthony ParkDistrict 13 - Union Park District Council District 14 - Macalester-GrovelandDistrict 15 - Highland ParkDistrict 16 - Summit Hill AssociationDistrict 17 - CapitolRiver CouncilUnknown - Other

16. City Council Ward*
    -- Select One --Ward 1Ward 2Ward 3Ward 4Ward 5Ward 6Ward 7Unknown - Other

17. Preferred Mailing Address

18. Street

19. City

20. State

21. Zip Code

22. Occupation

23. Place of Employment

24. Employment Address

25. In an attempt to ensure that committee representation reflects the makeup of our community, please check the box applicable to you. This information is strictly voluntary.

26. Race
    1. White (Caucasian)
    2. Hispanic
    3. Black (African-American)
    4. Asian or Pacific Islander
    5. American Indian or Alaskan Eskimo
    6. Other
27. Gender
    1. Female
    2. Male
    3. Not Specified

28. Disabled
    1. No
    2. Yes

29. If special accommodations are needed, please specify

30. Date of Birth
    Please use the format(MM/DD/YYYY)

31. Committee Information

32. Committee(s) Applied For*
    1. Advisory Committee on Aging
    2. Advisory Committee - People with Disabilities
    3. Bicycle Advisory Board
    4. Board of Water Commissioners
    5. Board of Zoning Appeals
    6. Business Review Council (BRC)
    7. Capital Improvement Budget (CIB) Committee
    8. Capitol Area Architectural Planning Board
    9. Capitol Region Watershed
    10. City-County Workforce Investment Board
    11. Civil Service Commission
    12. Cultural STAR Board
    13. Community Action Partnership of Ramsey and Washington Counties
    14. Community Health Services Advisory Committee
    15. District Energy Board of Directors
    16. Heritage Preservation Commission
    17. Homeless Advisory Board
    18. Human Rights & Equal Econ Opp Commission
    19. Metropolitan Airports Commission
    20. Minnesota Landmarks Board of Directors
    21. Mississippi Watershed Management Organization
    22. Neighborhood STAR Board
    23. Our Fair Carousel Board
    24. Parks and Recreation Commission
    25. Planning Commission
    26. Port Authority Board
    27. Police Civilian Review Commission
    28. Public Housing Agency
    29. Saint Paul Neighborhood Network
    30. Transportation Committee of the Planning Commission
    31. Ramsey County League of Local Government
    32. RiverCentre Authority
    33. RiverCentre Convention and Visitors Authority
    34. Truth in Sale of Housing Board of Evaluators
    35. Other
33. 
    

34. What skills/training or experience do you possess for the committee(s) for which you seek appointment?*

35. Reasons for your interest in this particular committee*

36. Have you had previous contact with the committee for which you are making application? If so, When and under what circumstances?*

37. Personal References

38. Reference #1

39. First Name*

40. Last Name

41. Address*

42. City*

43. State*

44. Zip Code*

45. Home Phone*

46. Cell Phone

47. Work Phone

48. Fax

49. Reference #2

50. First Name*

51. Last Name

52. Address*

53. City*

54. State*

55. Zip Code*

56. Home Phone*

57. Cell Phone

58. Work Phone

59. Fax

60. Reference #3

61. First Name*

62. Last Name

63. Address*

64. City*

65. State*

66. Zip Code*

67. Home Phone*

68. Cell Phone

69. Work Phone

70. Fax

71. How did you hear about this opening?

Leave This Blank:


72. 1. Receive email copy
73. Email address

74. Submit Submit and Print

* indicates a required field