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CITY OF 1VL&PLE GROVE <br />APPLICATION FOR APPOINTMENT TO CITY BOARD OR COMMISSION <br /> <br /> Data Privacy [ntbrmation <br />Tile inlbnnation provided by you ou this application will be used to determine your suitability for appointment to a board or commission with the <br />City of Maple Grove and to provide you with iufonnation pertaining to your application fbr this committee or board, If you are selected, a list <br />containing your name, address mid telephone number(s) will be distributed to appropriate staff: Participation as a board/commission member is <br />strictly voluntao', and you are aot required by law to furnish any of file information requested on this application. If you do not furnish this <br />intbrmation, however, we may have trouble determining your suitability for appointment, contacting you with information regardiug your <br />application and, if selected, witb your duties on the board or commission. <br /> <br />Under Minnesota State statutes, the following information about you is public: name, address and city/state/zip code, job histow, education and <br />training and work availability. Any other iufonnation collected on this application form is private data and will be accessible only to you, <br />pertineut Cio' of Maple Grove staff, or as provided tbr by Minnesota statutes. <br /> <br />BOARD OR COMMISSION PREFERENCE: <br />(Please rank itl order of preference) <br /> <br /> Arbor Committee <br /> <br /> Lake Quality Commission <br /> <br /> Planning Commission <br /> <br />Date: <br /> <br />Citizens Long Range Improvement Committee (CL1C) <br />Parks & Recreation Board <br /> <br />Transit Commission <br /> <br />Nan-re <br /> <br />Address <br /> <br />Resident of Maple Grove (years) <br />Name ofEmp oyer <br /> <br />Phone (home) <br /> <br />Occupation Phone (work) <br /> <br />Education (Please indicate highest grade completed or highest degree and major course of study) <br /> <br />Civic and Other ,Activities (Please list past and present civic activities and organizational memberships, particularly those which may <br />be relevant to the appointment you are seeking) <br /> <br />Comments (Briefly describe other qualifications, experience, and other information which you would like the City to consider or <br />which you believe are particularly relevant to the appointment you are seeking. Use additional pages as necessm'y.) <br /> <br />Return to: <br /> <br />Administration Depamnent <br />City of Maple Grove <br />P.O. Box 1180 <br />Maple Grove, MN.' 55311 <br />Telephone: 494-6004 <br /> <br />This application will be retained for one year fi'om date of receipt. <br /> <br />Date Received: <br /> <br />Date Appointed <br /> <br />-226- <br /> <br /> <br />