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Seat#	Term Start	Term End	Membership Requirements
{{applicationSeat.SeatNo}}	{{applicationSeat.TermStartDate \| date : common.constants.DATE_FORMATE}}	{{applicationSeat.TermEndDate \| date : common.constants.DATE_FORMATE}}	{{applicationSeat.MembershipNote}}

Applicant Details

First Name

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Last Name

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Home Address

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Home City

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Home State

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Home Postal Code

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Ward

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Home Phone

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Email Address

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Employer Information

Employer Name

Occupation

Employer Address

Employer City

Employer State

Postal Code

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Work Phone

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Fax Number

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NOTE: If appointed, Minnesota statute 13.601 requires that a telephone number and/or an email address where the appointee can be reached and residential address will be considered public data.

Public Contact Preference

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Describe your background related to any required or desirable qualification listed in the Notice. Include applicable experience with civic, professional or volunteer organizations and other city boards or commissions. List any awards or special recognition.

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List the reasons you want to serve on this body

List the issues that you believe the committee should address

References: List names,addresses and telephone numbers of no more than 3 references

References

Name

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Address

Phone Number

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Spanish - Atención. Si desea recibir asistencia gratuita para traducir esta información, llama 612-673-2700

Somali - Ogow. Haddii aad dooneyso in lagaa kaalmeeyo tarjamadda macluumaadkani oo lacag là aan wac 612-673-3500

Hmong - Ceeb toom. Yog koj xav tau kev pab txhais cov xov no rau koj dawb, hu 612-673-2800

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Application for Appointment to Minneapolis Advisory Committee On People With Disabilities

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