Application for Appointment to a Ramsey County Board, Committee or Commission

Thank you for your interest in serving on a Ramsey County Board, Committee or Commission.

Please complete this application form. Responses in the fields marked with an asterisk (*) are required.

Once you complete the form, click the Continue button.

1. Any false or incomplete information may be grounds for not appointing you to a volunteer assignment or ending your assignment after beginning volunteering.

2. You may be required to verify any or all of the information given on this application.

3. You authorize and release Ramsey County to contact prior employers, educational institutions and references.

4. You are responsible for notifying Ramsey County of any changes to your contact information (i.e., phone, email or address).

Committee for which you are seeking appointment

Please indicate the Ramsey County Committee, Board, or Commission for which you are seeking appointment.

Name and Contact Information

Please provide the following information.

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Work phone:

Cell phone:

Other phone:

Email address:

Please provide the name of your employer and your business address.

Reasons for Wishing to Serve on a Committee:

Please state your reasons for wishing to serve on the committee for which you are seeking appointment.

Applicable Background for Service

Please state your applicable background for service on the committee for which you are seeking appointment. List qualifications for membership if applicable (i.e., employment, education and/or related volunteer experience.

References

Please list the name, address and contact information of two persons who would be able to confirm your qualifications for this particular committee service.

1

2

Organization name:

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Email address:

Authorized Signature & Acknowledgements

The above data are being collected in support of your application for appointment to a Ramsey County Committee. The Ramsey County Commissioners, who will make appointments to the Committee, will review these data. You may refuse to provide these data. However, refusal to supply data may result in denial of your application for appointment to a committee. If you are chosen as a finalist to a committee, your application and the data it contains may become a part of the Board documentation, which is public data. If you are not chosen as a finalist to a committee, your application will be kept separate from the Board documentation, but the public data on your application (name and address) may be provided to the public, if requested. All other data on your application is considered private and will not be released to the public.

By checking the box (below) you certify that all of the information provided on this application is true and complete. You further authorize Ramsey County to contact the references you provided. Finally, you understand that you may be requested to appear for a personal interview should the County desire as part of its screening and selection process.

I Agree