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.

Contact Information

First Name*

Last Name

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code*

Home Phone*

Cell Phone

Work Phone

Fax

Email Address*

Personal Information

Planning District Council*

District 1 - Battle Creek / Highwood District 2 - The Greater East Side District 3 - West Side Citizens Organization District 4 - Dayton’s Bluff District 4 Community Council District 5 - Payne-Phalen District Five Planning Council District 6 - District 6 Planning Council District 7 - District 7 Planning Council District 8 - Summit-University Planning Council Ramsey Hill Association - The Ramsey Hill Association District 9 - Fort Road / West Seventh Federation District 10 - Como Park District 11 - Hamline-Midway District 12 - St. Anthony Park District 13 - Union Park District Council District 14 - Macalester-Groveland District 15 - Highland Park District 16 - Summit Hill Association District 17 - CapitolRiver Council Unknown - Other

City Council Ward*

Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Unknown - Other

Preferred Mailing Address

Street

City

State

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code

Occupation

Place of Employment

Employment Address

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.

Race

White (Caucasian) Hispanic Black (African-American)

Asian or Pacific Islander American Indian or Alaskan Eskimo Other

Gender

Female Male

Not Specified

Disabled

No

Yes

If special accommodations are needed, please specify

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

Committee Information

Committee(s) Applied For*

Advisory Committee on Aging Advisory Committee - People with Disabilities Bicycle Advisory Board Board of Water Commissioners Board of Zoning Appeals Business Review Council (BRC) Capital Improvement Budget (CIB) Committee Capitol Area Architectural Planning Board City-County Workforce Investment Board Civil Service Commission Cultural STAR Board Community Action Partnership of Ramsey and Washington Counties Community Health Services Advisory Committee District Energy Board of Directors Heritage Preservation Commission Homeless Advisory Board Human Rights & Equal Econ Opp Commission

Metropolitan Airports Commission Minnesota Landmarks Board of Directors Mississippi Watershed Management Organization Neighborhood STAR Board Our Fair Carousel Board Parks and Recreation Commission Planning Commission Port Authority Board Police Civilian Review Commission Public Housing Agency Saint Paul Neighborhood Network Ramsey County League of Local Government RiverCentre Authority RiverCentre Convention and Visitors Authority Truth in Sale of Housing Board of Evaluators Other

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

Reasons for your interest in this particular committee*

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

Personal References

Reference #1

First Name*

Last Name

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code*

Home Phone*

Cell Phone

Work Phone

Fax

Reference #2

First Name*

Last Name

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code*

Home Phone*

Cell Phone

Work Phone

Fax

Reference #3

First Name*

Last Name

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code*

Home Phone*

Cell Phone

Work Phone

Fax

How did you hear about this opening?