5.0. SR 01-06-1997'"~ty of
River
ITEH 5.
TO:
FROM:
DATE:
SUBJECT:
MEMORANDUM
Mayor and City Council
Sandra Thackeray, City Clerk
January 6, 1997
Board and Commission Interviews
On December 16, 1996, the City Council decided to interview
applicants for the Library Board, Planning Commission and Ice
Arena Commission. The applications for these attached to this
memo for your review. The interview schedule is listed below.
IN~RVIEW SCHEDULE
5.1.
5.2.
5.3.
5.5.
I,inda Ritchie - 6:10 p.m. (Library)
Murray McNair - 6:20 p.m. (Library)
Mary Sorenson - 6:30 p.m. (Library)
Judy Thompson - 6:35 p.m. (Planning)
Doran Cote - 6:45 p.m. (Planning)
5.6. Robert Galitz - 6:50 p.m. (Planning)
5.7. Thomas Kupka - 7:00 p.m. (Ice Arena)
5.8. Colleen Enerson - 7:10 p.m. (Ice Arena)
5.9. Patrick Mitzuk - 7:15 p.m. (Ice Arena)
5.10. Larry Toth - 7:20 p.m. (Ice Arena)
5.11. Ronald Johnson - 7:30 p.m. (ice Arena)
Please note that because Council meetings are public meetings, applicants
that are awaiting an interview may wait in the council chambers if they so
desire.
Library Board (2 vacancies)
*Linda Ritchie -
*Murray McNair -
Mary Sorenson
13065 Orono Parkway ° P.O. Box 490 ° Elk River, MN 55330 ° (612) 441-7420 ° Fax: (612) 441-7425
Planninff Commission (2 vacancies)
*Judy Thompson
Doran Cote
Robert Galitz
Ice Arena Commission (2 vacancies)
Thomas Kupka
Colleen Enerson
Patrick Mitzuk
Larry Toth
Ronald Johnson
Signifies current board or commission member whose term is expiring
The Council should note that some applicants have indicated at the
beginning of their application that they may be interested in serving
on other boards or commissions.
The chart below indicates existing board and commission members
whose terms are expiring and how many years each has served.
Number Number
Commission/Board Date of Terms of Years
Name Appointed Served Served
Park and Recreation Dave Anderson April, 1988 3 9
Park and Recreation Clair Olson January, 1992 1-2/3 5
Park and Recreation Kent Madsen August, 1995 1/2 1+
Planning Judy Thompson August, 1994 2/3 2+
Planning James Tacheny September, 1993 1 3+
Library Linda Ritchie February, 1995 2/3 2
Library Murray McNair January, 1993 1-1/3 4
HRA Duane September, 1986 2 10
Kropuenske
Utihties George Zabee January, 1988 3 9
ACTION REQUESTED
Interview candidates as hsted on interview schedule.
s:Xadmin\clerkXapplica.doc
City of
E
'vet
APPLICATION FOR APPOINTM[ENT TO
CITY BOARD OR COM~fISSION
Please indicate (by order of preference) which of the following you are
interested in (1,2,3 etc.):
--__ Economic Development Authority
~ Health Care Delivery Connnission
Housin~ and Redevelopment Authority
~ Library Board
~ Paa-k and Recreation Commission
~ Planning Commission
Utilities Commission
ADDRESS: \% ~\ ~-iwu~Vi¢~oo ~)-r.
PHONE: (Home) (Work)
OCCUPATION: ~k¥ ~ EMPLOXJER:
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would ]fl,'e to serve on the board or commisSion
selected above:
..EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or sMlls which quM~y
you to serve on this board or commission.
13065 Orono Parkway · RO. Box 490 · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
C__~rIC AJX~D COM~fUNITY ACTI~rITiES:
Describe past or present civic and/or community activities which may be
relevant in qualifyin~ you to serve on this board or commission.
ATTENDANCE:
Are you aware of the importance of regular meeting attendance inclua~ug the
time c_.,om~.. ~ent .,m.v.olved. m preparin~ for meetings, and do you feel you
have me tune ava.uaole to be an active participant: _~-/Yes ~ No
Comments:
_CONFLICT OF INTEREST;
I wish to disclose the following potential conflicts of interest that may or will
arise ffI become a member of this board or commission. /~.~, ~
The sel. ection process will vary according to the number of applicants and
vacanmes, and may not iudude inte.-~.dews 'z~th all can~dates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COIVIMISSION.
..Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, M~q 55330
Phone: 441-7420
s:\admin\brdcom~p.aoc
City of
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
River
Please indicate Coy order of preference) which of the following you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commi.~sion
Housing and Redevelopment Authority
Library Board
Park and Recreation Comm~,~sion
Plaun~ng Commi.~sion
Ut~Bties Commission
PHONE: (Home) (Work)
OCCUPATION: /(~ay-/~ 8 EMPLOYER:
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or commiasion
selected above: ~ #~£ ~f/~f~'~ti T/~M ~?~ {/~ ~i.~z~c£ /~z)
EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or skSlls which qualify
you to serve on this board or commission.
13065 Orono Parkway · P.O. Box 490 · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
~CIArIC AA~D COAfl~CUNITY ACTIXrITIES.
Describe past or present cix4c and/or community activities which may be
relevant in qualifying you to serve on this board or commission.
ATTENDANCE:
Are you aware of the ~mportance of regular meeting attendance includ~n g the
time commitment involved in preparing for meetings, and do you feel you
have the time available to be an active participant: . dyes .. No
COArFLICT OF INTEREST:
I wish to disclose the follo~4ng potential conflicts of interest that may or will
arise ffI become a member of this board or comm~.~sion.
The selection process will vary according to the number of applicants and
vacancies, and may not include inte,-views v,~+~ all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
CO1VfMISSION.
...Return Application To:
City Clerk's Of[ice
City of Elk River
PO Box 490
Elk lq/vet, 1VI2q 55330
Phone: 441-7420
s:\ad-~x~\brdcomap.doc
City of _ .,~t"'~,i~ APPLICATION FOR APPOINTMENT TO
? !
Date: //~/~
Please indicate ~y order of preference) which of the lo,owing you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Library Board
Park and Recreation Commission
Planning Commission
Utilities Commission
NAME: ~[~ ~ L, -~0~.~ k)
~ (Work)
PHONE: (Home~ _
OCCUPATION:Qtia~ ~~ EMPLOYER:
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or commission
selected above: t, fl bo(s~ FO k~e com~ i ~o~kw~a~8 ~c~,~ ;~'~
EDUOATION~ ~ PROFESSION~ EXPERIENOE-
Describe your educational and professional experience or skills which~.qualify .
you to serve on this board or commission. ~ ~6c~~ ~' ~ti~ ~ _~.,~_
13065 Orono Parkway · RO. Box 490 · Elk River, ~ 55330 · (6]2) 44]-7420 · Fax: (612) 44]-7425
CIX,qc AND COMMUNITY ACTI\qTIES:
Describe past or present civic and/or community activities which may be
relevant in quahfying you to serve on this board orx~ommission . __ ,-~ '
ATTENDANCE:
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings, and do you feel you
have the time available to be an active participant: ~/Yes . No
CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of interest that mayor, will
arise if I become a member of this board or commission. ~- (!o~ %
The selection process will vary according to the number of apphcants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
Appointment:
Date:
Term:
OFFICE USE
s:\admin\brdcomap.doc
City of
APPLICATION FOR APPOINTMENT TO
CITY BOA_RD OR COMMISSION
River
Please indicate (by order of preference) which of the following you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Library Board
Park and Recreation Commi.~sion
~ Planning Commi-~sion
.... Utilities Commission
PHON'E: (I-Iome), (Work)
OCCUPATION: ~cc~- ~ ;$(~ EMPLOYER: ~{ ~' ,'x ~'\ ¢,~ i'~t
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would li~-e to serve on the board or commission
selected above:
_EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or s~]L~ which quM~6y
you to serve on th~s board or commission.
13065 Orono Parkway · P.O. Box 490 · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
.C1A"IC AA~D COM~-Lr~TITY ACTIVITIES:
Describe past or present civic and/or community activities wkich may be
relevant in qu~g you to serve on tiffs board or commission.
ATTENDANCE:
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings, and do you feel you
have the time available to be an active participant: /~Yes No
Comments:
~CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of interest that may or will
arise ffI become a member of th~.~ board or comm~.~sion.
The selection process will vary accora~ng to the number of applicants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, 1VIN 55330
Phone: 441-7420
s:\admin\brdcomap.doc
STATEMENT OF INTEREST: I am currently completing a 3 year term as
Elk River Planning Commissioner. During that term, the commission
completed an updating of the city's comprehensive plan. Being part
of that process has increased my insight into how important it is
to have informed citizen representation involved in the planning
and zoning issues of a city. My strongest interests lie in the
preservation of our historic downtown, development of a riverfront
pathway, and preservation of our natural resources.
EDUCATION AND PROFESSIONAL EXPERIENCE: For the past 3 years, the
City of Elk River has invested in my education and training as a
Planning Commissioner by sending me to national, state and local
planning conferences. Due to this training, I believe that in a
second term as planning commissioner I should prove to be a more
effective representative of that commission.
Additionally, I possess a Bachelor of Science in Accounting, and
have been employed in Hennepin Parks' Finance department for the
past 15 years.
CIVIC AND COMMUNITY ACTIVITIES: I am the current Chair for the
City of Elk River Planning Commission, the current Chair for
Hennepin Parks' Deferred Compensation Committee, a current member
of Hennepin Parks' Fees Committee and Marketing Committee. I was
past Chair for Hennepin Parks' Employee Club and vice Chair for the
University of Minnesota's Student Board.
ATTENDANCE: Yes. In the past three years, I have missed only one
Planning Commission meeting. I do believe that if you make a
commitment to become a member of the Planning Commission, it is
important that you attend all meetings and workshops to stay
current with planning issues.
CONFLICT OF INTEREST: I can think of no conflict of interest that
could occur for me. None have occurred in the past three years.
I work for Hennepin Parks, which is partially funded by the
Metropolitan Council, Hennepin County and Carver County. I can't
imagine any situation which would lead to a conflict due to my
employment.
City of
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
'ver
-__ Economic Development Authorit~
~ Health Care Delivery Commissio]
.. Housing and Redevelopment Ant3
.,, Library Board
~- Park and Recreation Commission
/-.LL_Planning Commission
--5__ Utilities Commission
NAME:
ADDRESS:
PHONE: (Home)
OCCUPATION: .,~
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
(Work)
EMPLOYER:
STATEMENT OF INTEREST:
Please explain why you would Ii]ce to serve on the board or commission
selected above:
~_./~. A~/~ ~/~.1~,/~ ~/~ ~¢~-~p,~,..
Describe your educational and professional experience or skSUs which qualify
you to serve on this board or commission.
13065 Orono Parkway · P.O. Box 490 · Elk River, MN 55330/. (612) 441-7420'.-Fax: (612) 441~425 '
.crvIc AND COM]VlUNITY ACT1ZrITIES:
Describe past or present civic and/or community activities which may be
evant in qu~g you to serve on this board or commission.
ATTENDANCE:
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings, and do you feel you
have the time available to be an active participant: ~ Yes . No
Comments:
,CONFLICT OF INTEREST:
I wish to disclose the following potential COnflicts of interest that may or will
arise ffI become a member of this board or commission.
The selection process will vary according to the number of applicants and
vacancies, and may not include interviews ~4th all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To'
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
s:\admln \brdcomap.doc
City of
iver
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
Date: /v'~,c, f;R /~
Please indicate (by order of preference) which of the following you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Library Board
Park and Recreation Commission
Planning Commission
Utilities Commission
PHONE: (Home) '(Work) : ~
OCCUPATION: ./~ 7-,,~-~ EMPLOYER: /~.~, ~_r/L.
HOW MANY YEAES HAVE YOU LIVED IN ELK RIVER? ~--_~ ~
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or commission
selected above: 7'o Cc.,,.,7'~/'/;oT',-: ~'~s,) ~ 7- 3% ,~'~ C~,,,,..,,,~,~"7"y.~
EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or skills which qualify
you to serve on this board or commission.
13065 Orono Parkway · P.O. Box 490 · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
CMC AND COMMUNITY ACTIVITIES:
Describe past or present civic and/or community activities which may be
relevant in qualifying you to serve on this board or commission.
ATTENDANCE:
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings, and do you feel you
have the time available to be an active participant: XV Yes No
Comments:
aZ-:
CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of interest that may or will
arise if I become a member of this board or commission.
The selection process will vary according to the number of applicants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
Appointment:
Date:
Term:
OFFICE USE
s:\admin\brdcomap.doc
'";ty of
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
River
11/1~/96
Date:
Please indicate Coy order of preference) which of the following you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Library Board
Park and Recreation Commission
Planning Commission
Utilities Commission
X 'r
.,_ce Arena Commission
NAME:
Thomas J. Kupka
12717 274th Circle Zimmerman, MN 55398
ADDRESS:
PHONE: (Home) (Work)
Change-over
OCCUPATION: operation -EMPLOYER: Ogden Entertainment
Mgr. (Target Center)
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER? 3½ (zimmerman)
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or commission
selected above:
Getting involved in a project that has the potential to
the best Ice facility in Central Minnesota.
become
EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or ski]Is which qualify
you to serve on this board or commission.
SEE ATTACHED RESUME
13065 Orono Parkway · P.O. Box 490 · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
_CIVIC AND COMMUNITY ACTIVITIES:
Describe pastorpresentcivic an~orcommunity activities which maybe
relevant in qualifying you to serve on this board or commission.
I have coached young athletes in youth sports programs
both the Brooklyn Park and Elk River communities.
in
ATTENDANCE:
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings, and do you feel you
have the time available to be an active participant: x Yes No
Comments:
,CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of interest that may or will
arise if I become a member of this board or commission.
n;tye
The selection process will vary according to the number of apphcants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
Appointment:
Date:
Term:
OFFICE USE
s:\admin\brdcom ap.doc
THOMAS J. KUPKA
12717 2?4th Circle
Zimmerman, MN 55398
Home: (612)
Work: (61
WORK EXPERIENCE: OGDEN ENTERTAINMENT SERVICES
(Change-Over Operations Manager)
4/94
to
Present
Directly responsible for the set up and tear down of
all events at the Target Center. These events include:
NBA Basketball, College and Professional Xockey, NCAA
events, major concerts, banquets, and other events.
18/98
to
4/94
OGDEN ENTERTAINMENT SERVICES
(Concession/Purchasing/Warehouse MGR.)
Target Center- Mpls, MN
Cantebury Downs Race Track
Shakopee, MN
St. Croix Meadows Greyhound
Racing Park- Hudson, WI
Responsible for all phases of concession operations
including: Purchasing of product, hiring and training of
employees, stocking and maintenance of all concession
stands. Directly responsible for monthly inventory, plan
and prepare work schedule and assign employees to
specific duties. Directly involved in opening new
accounts.
5/79
to
3/92
Education:
Waterproofing Inc., Blaine, MN
(Foreman)
Responsible for supervising daily operation of
commercial and residential building contracts.
St. Cloud State University
Owens Corning Sales and Marketing Seminar
Supervisory Management Seminar
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
Date:
Please indicate (by order of preference) which of the following you are
interested in (1,2,3 etc.):
EcononLic Development Authority
Health Care Dehvery Commission
Housing and Redevelopment Authority
Ice Arena Commission
Library Board
Paz-k and Recreation Commission
Planning Commission
Utilities Commission
PHONE: (Home)_ .... (Work) ~)
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would like to serve on the boza'd or commission
selected above:
EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educCtional and professional experience or skills which qualify
you to smwe on this board or commission.
13065 Orono Parkway · P.O. Box 490 · Elk River. MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
CIVIC AND COMMUNITY ACTIVITIES:
Describe past or present civic and/or community activities which may be
relevant in qualifying you to serve on this board or commission.
~ucCl.,w~ · ,-'"'; ~. . . . ~ ' '
ATTENDANCE: ~ ~'lc~.'] rr~ c~/~-~ a~,'(fu._ ~~-~t,~&~,ct~ ~ ~,, ~
Are you aware of the imp~rta~~~ meeting attendancev - including the
time commitment involved in preparing for meetings~,.,and do you feel you
have the time available to be an active participant: ~_ '/es No
Comments:
CONFLICT OF ~NTEREST: '
I wish to disclose the following potential conflicts of interest that may or will
arise ffI become a member of this board or commission.
Signature
The selection process ~411 vary according to the number of apphcants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Apphcation To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
Appointment:
Date:
Term:
OFFICE USE
s:kforms\brdcomap.doc
";ty of
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
·
lver Date:
Please indicate (by order of preference) which of the following you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Ice Arena Commission
Library Board
Park and Recreation Commission
Planning Commission
Utilities Commission
Ice Arena Commission
PHONE: (Home)
OCCUPATION: ']'-~A % [-~ ~ ~
N.MJ.
(Work).
EMPLOYER:
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or commission
selected above:
EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or skills which qualify
you to serve on this board or commission.
~ :i'~- ~'ii 'Btmlk~: 5533:~44:-7420)o Fix· (619) 441-7495'
13065Orono;ba .p~~'
CIVIC AND COMMUNITY ACTIVITIES:
Describe past or present civic and/or community activities which may be
relevarkt in qualifying ygu to serve on this,board or commission
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings, aj~t do you feel you.
have the time available to be an active participant: ~ Yes No
Comments:
CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of interest that may or will
arise if I become a member of this board or commission.
The selection process will vary accora~ng to the number of applicants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
Appointment:
Date:
Term:
OFFICE USE
City of~
Z,11 River
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
Please indicate by order which of the following you are
interested in (1,2,3 etc.)
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Library Board
Park and Recreation Commission~w ~--/iJ~L ,,,
Planning Commission
Utilities Conunission
PHONE: (Home). (Work).
OCCUPATION_~/D6,5 ~- ! d~ }- F.'/'- EMPLOYER L(
HOW MANY YEARS HAVE YOU LIVED IN ELK RIVER?
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or
commission selected above?
Describe your educational and professional experience or skills
which qualify you to serve on this board or commission.
P.O. Box 490 · 13065 Orono Parkway · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
CIVIC AND COMMUNITY ACTIVITIES:
Describe past or present civic and/or community activities
which may be relevant in qualifying you to serve on this board
or commission.
ATTENDANCE:
Are you aware of the importance of regular meeting attendance
including the time commitment involved in preparing for
meetings, and do you feel you have the time available to be an
.active participant? ~f Yes No .
Comments:
CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of
interest that may or will arise if I become a member of this
board or commission.
The selection process will vary according to the number of
applicants and vacancies, and may not include interviews with
all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR COMMISSION.
'Return ADDlication TO:
City Clerks Office
City of Elk River
PO Box 490 - 13065 Orono Parkway
Elk River, Mn 55330
Phone 441-7420
""ity of
APPLICATION FOR APPOINTMENT TO
CITY BOARD OR COMMISSION
iver
Please indicate (by order of preference) which of the following you are
interested in (1,2,3 etc.):
Economic Development Authority
Health Care Delivery Commission
Housing and Redevelopment Authority
Ice Arena Commission
Library Board
Park and Recreation Commission
Planning Commission
Utihties Commission
Ice Arena Commission
NAME:
ADDRESS:
PHONE: (Home)
O CCUPATI O N:/~Y.-fz?/,f/~/~,'~'~,~Y¢/--E M P LOYER:
HOW MANY YEARS HAVE YOU LIVED IN ELK RIV~,. R? ,
STATEMENT OF INTEREST:
Please explain why you would like to serve on the board or commission
selected above:
EDUCATIONAL AND PROFESSIONAL EXPERIENCE:
Describe your educational and professional experience or skills which qualify
you to serve on this board or commission.
13065 Orono Parkway · P.O. Box 490 · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
CIVIC AND COMMUNITY ACTIVITIES:
Describe past or present civic and/or community activities which may be
relevant in qualifying you to serve on this board or commission.
ATTENDANCE:
Are you aware of the importance of regular meeting attendance including the
time commitment involved in preparing for meetings,,an_~do you feel you
have the time available to be an active participant: ~"Yes No
Comments:
CONFLICT OF INTEREST:
I wish to disclose the following potential conflicts of interest that may or will
arise ff I become a member of this board or commission.
The selection process will vary according to the number of applicants and
vacancies, and may not include interviews with all candidates.
THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR
COMMISSION.
Return Application To:
City Clerk's Office
City of Elk River
PO Box 490
Elk River, MN 55330
Phone: 441-7420
Appointment:
Date:
. Term:
OFFICE USE