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Multicultural Advisory Committee Application Form
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Thank you for your interest in volunteering with the City of Roseville. Roseville has a rich history of citizen engagement and volunteering. We look forward to you joining our team as we work together to create a safe, livable and vibrant community.
Are you representing an organization?
Minnesota State Statute §13.601 states that once an individual is appointed to a public body, the following additional items of data are public:
(1) residential address; and
(2) either a telephone number or electronic mail address where the appointee can be reached, or both at the request of the appointee
Please answer the questions below to help us assess your qualifications for a position on the Multicultural Advisory Committee.
1. If you live or work in Roseville, skip this question and go to question two below. If you do not live or work in Roseville, please explain your connection to this city and the well-being of its residents.
2. Please describe the cultural, racial, ethnic, or other group you wish to represent on the Multicultural Advisory Committee.
3. Briefly describe any other qualifications, experiences, or information you believe may be relevant to your inclusion on the committee.
In addition to English, what languages do you speak and/or write?
Optional: You may provide the following information. It may be used to help us get a better idea of the demographic make-up of our volunteers. Only City of Roseville Volunteer Services staff will view this information.
-- Select One --
-- Select One --
-- Select One --
Adult over age 50
My availability is:
-- Select One --
On-going, except between these dates
Only between these dates
The best day(s) of the week for me to volunteer are:
I prefer to volunteer during:
How did you hear about the Multicultural Advisory Committee??
I certify that the facts set forth in the volunteer application are true to the best of my knowledge. I understand that any falsification, misrepresentation or concealment of information on this application may be sufficient grounds for disqualification for volunteering or immediate discharge and that the City of Roseville shall not be liable in any respect if my volunteering is so denied or terminated. I understand that this completed application is the property of City of Roseville and will not be returned. I understand that I must notify the Multicultural Advisory Committee Volunteer Coordinator of any changes in my name, address, or phone number. I understand that I am applying for a volunteer position and that I will not be paid in any way. Volunteers are responsible for maintaining the confidentiality of all non-public information which they are exposed while serving as a volunteer. Failure to maintain confidentiality may result in termination of the volunteer's relationship with the City or other corrective action.
DATA PRIVACY NOTICE
Minnesota law requires that you be informed of the purposes and intended uses of the information you provide to the City of Roseville during the application process or during volunteer assignments. Any information about yourself that you provide during the application and interview process will be used to distinguish you from other applicants and identify you in our program records; as well as enabling us to contact you. The information which you will be asked to provide in this application process is considered private data: name, address, home phone number, gender and age. Private data is available only to you and to other persons at the City of Roseville who have a bona fide need for that data. Public data is available to anyone requesting it and consists of all data furnished in the application process, which is not designated in this notice as private data. Please note that the City does not share information gathered through its sites with third parties for promotional purposes.
Although you are not legally required to supply information, if you do not supply the information requested, it may mean that your application is not considered.
If I am selected as a volunteer for the City of Roseville, I give my permission for photo/video footage taken of me working as a volunteer to be used by the City of Roseville for marketing purposes.
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