02.c Michael Marosok Planning Commission ApplicationCommittee or Commission Application
Name *Address *
Phone *Email *
Residency *
Committee or
Committee *
Have you served on
any Scandia
Committee or
Commission in the
past?*
Experience
Special Interests
Volunteer History
Optional
In accordance with M.S. 13.04 Subd. 2 we must inform you of your rights as a subject of government
data. The information you give us about yourself is needed to identify you and assist in determining your
suitability for the positions(s) for which you are applying. The information that we collect about you is
classified as either Public or Private. Public means that it is available to anyone who asks to see it. Private
means that the information is available only to the person the information is about and to the staff who
must use it in the normal course of conducting City business and as otherwise provided for by law.
By entering my full name, I am affixing my signature to this application and acknowledging that an
investigation may be conducted for use in determining my qualifications. I hereby expressly
authorize release of any and all information which any organization, company or person may have,
including information of a confidential or privileged nature. I hereby release the City and any
organization, company or person furnishing information to the City, as expressly authorized above,
from any liability for damage which may result from furnishing the information requested.
Michael PO Box 186
(
35 years
How long have you been a resident of Scandia?
Select the Committee you are applying to:
Capital Investment Committee Parks and Recreation Committee
Planning Commission Tourism Committee Wastewater Committee
Economic Development Authority (EDA)
Yes
No
List any governmental, service organizations, or professional activities which you have been or currently are
involved in:
Cub/Boy Scouts, Den Leader, Scout Master and Assistant Scout
Master, Committee member, 16 years total. Association Board
President 7 years. Business Owner 39 years, Church governing
board member and Administrative leader 5 years.
List any of your special interests, activities or hobbies which you have that would apply to this committee:
Real estate and construction professional for over 40 years. Hiking,
Biking enthusiast.
In what volunteer activities have you participated? What was your role?
Scout Leader 16 years, Church pastoral leader in various capacities
including Congregation Administrator, financial, teacher, teacher
development, youth leader, activities chair, 41 years total.
You may attach a resume. The selection process will vary according to the number of applicants and vacancies.
Your application will be kept on file for one year.
Signature *Michael Marosok
Typing your name in the box will be considered an electronic signature