3.j Discussion on Community Center Committee appointments■ i ■
in i n n e s o t a
Application for Appointment
To Commission or Committee
Committee/Area of Interest : LC,IA X,,WU C ev1,k✓ V&,L F04 -CC
RECEIVED
MAY 31 2019
CITY OF SCANDIA
Name: Home Phone: l3q - -2-0-0'2:L8 cr
(Os t-4013 -44YZ
Home Address: TO _60K 12-1 ZA5:Uj GLUOkC. Nc' AVS Zip: 55013
SC--oaIz 1 I+"'N
E -Mail Address: ❑ k�vn C -U) e- V) -Sm I tk Z q VA §t , Lwvl
How long have you been a resident of Scandia? MV �Oj VS 44\OMC bH\ �GXAaia MI
k%VC, 1 &-C . h ahrc owsnc� a Hoc S Mcc 2010,
Property owned in Scandia (other than residence):
Employment
Present Employer: NCA,,4y.1rst tAStxV-8�y1Ce_ LLC- Worked There Since (mo/yr): J611. i I. 36
Work Phone: 20 3 •- G 2,2- 5Z1i -,� I Position Title: OWAC. , 4tyCC_ Lv of
Commission/Committee Experience
Commission/ Committee ftUW5-e LBVId�A_Dates Served 20tZo1S
COM tA i i tCC V ^koew
Educational Sackeround
Highest Level Achieved (degree/major): _tit c D"e_
Other Experience
List any governmental, service organizations, or professional activities which you have been or
currently are involved in: Sci,,n&k'k kkc_�&yr kM e
1 W ow�cns ers� ► C�wnc►1 ,cv4�s c+-
�:�c�ns��n�
Wt bcr"c," { i hhe/tcar Den--cgvl -F%Yy'l'
In what volunteer activities have you participated? What was your role?
l a � W u�vva,ti s L��c��►17 Ccxu`� c.c,1, , ��✓d. u�tw►,L4-ev-
C7�C.+r.��
COMOUUWo l 4'55oc, S
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.
As the person executing this application, I acknowledge that an investigation may be conducted for use in determining my
qualifications. 1 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.
Signature: —4yyt N 1 �_ Date: zci �1
You may attach a resume if you desire. The selection process will vary according to the number of
applicants and vacancies and may include interviews. Your application will be kept on file for one
year. Thank you for your interest in serving on a Commission or Committee.
Return completed application to: City of Scandia
14727 2091h Street North
Scandia, MN 55073
Phone: 651.433.2274 Fax: 651.433.5112
E-mail: n.soltis@ci.scandia.mn.us
Application for Appointment
To Commission or Committee
RECEIVED
CITY OF SCANDIA
Committee/Area of Interest
C v mvoj�-v -+� 'ems -%v- 1 a ,6Z %D\ -C e
�srU�Name: S i Home Phone: 4LS/- Z33- 24� %
J
Home Address: ;-I H So Pp vv\Zip:
E -Mail Address:
How long have you been a resident of Scandia?
Property owned in Scandia (other than residence):
Employment
Present Employer: wie4E[,:D�D 1'(_ Worked There Since (mo/yr):
Work Phone: (��21 - 2 - L ]Position Title: �,r
{ ccMn V, M_t-
Commission/Conimittee Experience
Ir -
Commission/ Committee omit I�GUI1 Dates Served o -.o i 1
f -rct-,,+e c m Ci d 2 U` (\kD Czymv, #{ — Gin cc,r
Educational Backeround
Highest Level Achieved (degree/major): � n ) m kG w
WIP V el l h'1 Of CI VV1 RA c0fCk__
Other Experience
List any governmental, service organizations, or professional activities which you have been or
currently are involved in: j to I ❑eAL-)L dl --
W,
In what volunteer activities have you participated? What was your role?
Ck
Ir
00ANV, Gvn *4
S � i kL,;�4
ke Q/m
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.
As the person executing this application, I acknowledge 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 requ d.
1
Signature: )'(�'L' Date:
You may attach a resume if you desire. The selection process will vary according to the number of
applicants and vacancies and may include interviews. Your application will be kept on file for one
year. Thank you for your interest in serving on a Commission or Committee.
Return completed application to: City of Scandia
14727 209t4 Street North
Scandia, MN 55073
Phone: 651.433.2274 Fax: 651.433.5112
E-mail: n.soltis@ci.scandia.mn.us
1I1 1 11 ]1 C S O t a
Application for Appointment
To Commission or Committee
Committee/Area of Interest: Community Center Task Force Members
Name: Julie Gacek
Home Address: 12680 Scandia Trail
E -Mail Address: Julie@redeemedfarm.org
How long have you been a resident of Scandia?
Property owned in Scandia (other than residence):
Present Employer:
Redeemed Farm
Work Phone: 612.757.3597
RECEIVED
FIAT J i c.0 1 a
CITY OF SCANDIA
Home Phone: 612.757.3597
5 years
Redeemed Farm
Employment
Zip: 55073
Worked There Since (mo/yr): 5 years
Position Title: Owner
Commission/Committee Experience
Commission/ Committee N/A Dates Served N/A
Educational Background
Highest Level Achieved (degree/major): College
Other Experience
List any governmental, service organizations, or professional activities which you have been or
currently are involved in: Healing Haiti
In what volunteer activities have you participated? What was your role?
Event Planning, Sponsorship, Mission Trip
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.
As the person executing this application, I acknowledge 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.
Signature: _ % ILEI 644 Date: 5.31.19
You may attach a resume if you desire. The selection process will vary according to the number of
applicants and vacancies and may include interviews. Your application will be kept on file for one
year. Thank you for your interest in serving on a Commission or Committee.
Return completed application to: City of Scandia
14727209 1h Street North
Scandia, MN 55073
Phone: 651.433.2274 Fax: 651.433.5112
E-mail: n.soltis@ci.scandia.mn.us