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Commissioner Authorizations and Demographic Questionnaire

  1. Commissioner Handbook*

    I have reviewed and understand the commissioner handbook.

  2. Attendance Policy*

    I understand that I must attend at least 80% of commission meetings. If I am unable to attend a meeting, it is my responsibility to inform the commission chair and staff liaison.

  3. Mandatory Ethics Training*

    As a city leader, I understand that I must attend the ethics training on April 12, 2023 at City Hall or inform the commission staff liaison as soon as possible of any scheduling conflicts.

  4. Demographic Questionnaire

    The City of Roseville is committed to ensuring a wide variety of perspectives and experiences are represented by our commissioners. The information captured by the Demographics Questionnaire portion of this form will not be made available except in aggregate or statistical analysis of commissioners. This information will be used to help us understand how we can continue to improve our commitment to diversity, and our onboarding and recruitment efforts. 

  5. What is your employment status? (Check all that apply)*
  6. What is your race/ethnicity? (Check all that apply)*
  7. Minnesota Government Data Practices Act*

    I understand that information provided in this application may be distributed by the City to the public including, but not limited to, being posted on the City of Roseville website. I agree to waive any and all claims under the Minnesota Government Data Practices Act, or any other applicable state and federal law, that in any way related to the dissemination to the public of information contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the information provided.

  8. Minnesota Statute §13.601. subd. 3(b)*

    Occasionally, City staff receive requests from the media or from the public for ways to contact Commission members. The Commission roster is periodically made available. Under Minnesota Statute §13.601. subd. 3(b), either a telephone or electronic mail address (or both) where you can be reached must be made available to the public. Please indicate which contact method the City may make available for inclusion on the Commission roster. 

  9. Acknowledgement

    I have read and understand the statements on this form, and I hereby swear or affirm that the statements on this form are true.

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  11. This field is not part of the form submission.