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Volunteer Organization Position Held <br /> Street City State Zip <br /> Immediate Supervisor Phone No. <br /> Dates of Participation Hours Per Week <br /> Skills Learned <br /> Accommodations <br /> Do you have any physical or health limitations that would require special or <br /> reasonable accommodations by the City: Yes No <br /> If yes, please describe the nature of the accommo ation: <br /> Employment of Relatives <br /> List any relatives currently employed by the City of Arden Hills <br /> Name Relationship To You <br /> Personal References <br /> (Not former employees or relatives) <br /> Name and Occupation Address Phone Number <br /> I I I I <br /> Tennesseen Warning/Data Practices Notice to All Applicants <br /> The Minnesota Government Data Practices Act requires that you be informed <br /> of the purposes and intended uses of the information you provided to the City <br /> of Arden Hills during the application process or during employment. Any <br /> information about yourself that you provide will be used to identify you as an <br /> applicant and to assess your qualifications for employment with the City. if <br /> you wish to be considered for employment, you are required to provide the <br /> information requested in the Application for Employment. If you refuse to <br /> nttos://mail-attachment.googleusercontent.com/atiacliment/u/O/...SrHmTb4uCEuDfBgKEYSCRDCp2X5NjLj9u 32tzifNzHW2dXrhpK6 5/4/17,9:45 PM <br /> �aqe 7 of 12 <br />