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Please complete ONE application for each committee you are seeking. Notice of Rights identified on next page.
I agree and consent to providing a digital signature.
In accordance with the Minnesota Government Data Practices Act, Chisago County is required to inform you of your rights as they pertain to private information collected from you. Private data is that information which is available to you, Chisago County Administration and the department to which you are applying, but not to the public.
The purpose of the collected information is to determine your eligibility to participate on a commission or advisory board. Furnishing the requested information is voluntary, although refusal to supply the information may make you ineligible for an appointment.
Names and home addresses of applicants for appointment to the members of an advisory or commission are public, as are rank on eligibility list, job history, education, training and work availability. All other information obtained from you is private.
Completion of this form is optional. It is not part of the application process. The purpose of this form is to authorize release of your Email (if any) and fax or telephone number(s) to members of the Chisago County Board of Commissioners. Authorizing release of your contact information is not required. If you decline to complete this release, the commissioners who will make the decision regarding your application for appointment to the committee, board or commission will not be able to contact you in advance of his/her decision to vote.
If you have a question about anything on this form, or would like more explanation, please contact the Clerk to the County Board before you sign it.
As an applicant for an opening with one of Chisago County's committees, boards or commissions, I understand that I have a right to have some personal information remain private. I recognize Chisago County Commissioners may want to contact me and inquire about my interest and qualifications regarding this position.
Please enter your name above to: Hereby waive your right to keep the specified data private.
Please enter your name above if you wish to: Give your permission for Chisago County to release data about yourself to Chisago County Commissioners currently serving on the Chisago County Board of Commissioners, as described on this form.
This authorization to release expires ninety (90) days from the date of my signature OR upon the filling of the position on the committee, board, or commission, whichever comes first.
Please list the names, complete addresses, including the zip code, and daytime phone numbers of three references.
This field is not part of the form submission.
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