11. PRC Sub Committee Application - JohnsonsCAvvILA
City of Scandia
Application for Appointment to
Parks & Recreation Sub -Committee
Playground Equipment Replacement
First Name * Last Name
Christine Johnson
Name of Nominator
* Email Phone
Contact Information of Nominator
Address
21889 Oldfield Ave N
* How long have you been a resident in Scandia?
11 years
* Have you served on any Scandia Commission or Committee?
No
If yes, please indicate which one and when
* List any governmental, service organizations, or professional activities which you have been or currently are involved in:
None
* In what volunteer activities have you participated? What was your role?
Volunteer dog walker and new volunteer trainer at Northwoods Humane Society - 8 years
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
Christine L Johnson
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.
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