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f- ~ <br />APPLICATION <br />ROSEVILLE CHARTER COMMISSION <br />Mail completed application to: <br />Michael Moriarity, Court Administrator <br />600 Courthouse - 15 W. Kellogg Blvd. <br />St. Paul, MN 55102 <br />Full Name (type or print): <br />Address: <br />Years at this address: <br />Telephone Home: Work or Other: <br />QUALIFICATIONS TO BE CONSIDERED <br />EDUCATION: <br />EMPLOYMENT, OCCUPATION OR OTHER EXPERIENCE: <br />MEMBERSHIPS, ACCOMPLISHMENTS OR OTHER QUALIFICATIONS: <br />PLEASE STATE YOUR REASONS FOR WANTING TO SERVE ON THIS COMMITTEE: <br />Your response to any of the above maybe continued on the back and you may attach any other materials <br />which you may want to be considered. <br />SIGNATURE: DATE: <br />Roseville is committed to the policy that all persons shall have equal access to their programs, facilities <br />and employment without regard to race, creed, color, sex, age, national origin or handicap <br />at~a9~9~ <br />