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2002-07-02 P & Z Agenda
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2002-07-02 P & Z Agenda
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<br />, Personal Infonnatlon - Part 2 <br /> <br />list the names, residence addresses and phone numbers ofthree residents: a) ofthe seven-county Twin Cities metro area <br />- if you reside in the metro area, or, b) in the county in which you live - if you live out of the metro area or in another state, <br />of good moral character, not relaled 10 the applicant or financially interested in the premises or business, who may be <br />referred to as to the applicant's character. Submit II written reference letter from each person listed below. <br /> <br />1) Full Name: Phone: <br /> <br />2) <br /> <br />3) <br /> <br />I HEREBY UNDERSTAND AND AGREE THAT: <br /> <br />1. <br /> <br />INFORMATION REVEALED BY AN APPLICANT FOR AN OCCUPATIONAL LICENSE IN THE CITY OF MINNETONKA WILL <br />BE USED BY THE CITY IN ACCORDANCE WITH FEDERAL AND STATE LAWS REGARDING PRIVACY OF CRIMINAL <br />RECORDS. <br /> <br />A CRIMINAL CONVICTION WILL NOT BAR AN APPLICANT FROM OBTAINING A LICENSE WITH THE CITY OF <br />MINNETONKA UNLESS SUCH CONVICTION IS DIRECTLY RELATED TO THE OCCUPATION FOR WHICH THE LICENSE <br />IS SOUGHT, ACCORDING TO MINNESOTA STATUTES ~364.03. <br /> <br />HOWEVER, FAILURE TO REVEAL A CRIMINAL CONVICTION WILL BE CONSIDEREO FALSIFICATION OF THE <br />APPLICATION AND MAY BE USED AS GROUNDS FOR DENIAL OF THE APPLICATION. <br /> <br />I DECLARE THAT THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS TRUTHFUL, AND I AUTHORIZE THE CITY <br />OF MINNETONKA TO INVESTIGATE THE INFORMATION AND CONTACT THE PERSONS NAMED ON THE APPLICATION. <br /> <br />,. <br /> <br />3. <br /> <br />I HEREBY AGREE TO NOTIFY THE CITY OF ANY CHANGE IN THE INFORMATION PRESENTED HERE WHICH MAY OCCUR <br />DURING THE LICENSE PERIOD. <br /> <br />I HEREBY AUTHORIZE THE CITY OF MINNETONKA TO HAVE ACCESS TO ALL SOURCES OF INFORMATION WHICH MAY BE <br />CONSULTED TO VERIFY THE INFORMATION I HAVE PROVIDED ABOVE. THIS INCLUDES AUTHORIZATION TO CHECK <br />CRIMINAL HISTORY RECORDS IF I HAVE BEEN ASKED TO PROVIDE THAT INFORMATION. <br /> <br />x <br /> <br />(SIgnatl.lrfl of Applicant) <br /> <br />Subscribed and sworn to before me a Notary Public <br /> <br />on this <br /> <br />day of <br /> <br />,19_. <br /> <br />Commission expires on: <br /> <br />. <br /> <br />(NcI8l)lPubJlc) <br /> <br />H:\WP\FORMS\PERINFB1_MAS <br /> <br />(3) <br />
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