2. 

3. City of Coon Rapids
   Advisory Commission Application

   
   

   Please complete this form to apply for a voluntary position on a City board or commission.

5. Name:*
7. Address:*
8. ZIP:*
10. Home Phone Number:
11. Work Phone Number:
12. Cell Phone Number:*
14. Email Address:*
18. Please rank in numerical order the commissions on which you wish to serve:

    Leave blank any commission on which you do not wish to serve.

20. Arts
21. Board of Adjustment and Appeals
22. Charter
24. Civil Service (Police and Fire)
25. Historical
26. Parks and Recreation
28. Planning
29. Sustainable Community (Green)
33. Briefly share your work experience:
35. List any volunteer, civic, professional and/or community activities:
37. Please state why you want to be on an advisory commission:
39. What skills, strengths or abilities do you believe you will add to the commission?
41. Additional comments:
43. References (optional)

    Please include: Name, Address, Phone Number

47. Government Data Practices Act - Tennessen Warning:*

    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, with 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.  

    1. I acknowledge the Government Data Practices Act - Tennessen Warning.
49. Electronic Signature (Typing your name constitutes signature)*
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field