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Commission Member Application

  1. This application is for Roseville residents interested in volunteering with a City of Roseville Advisory Commission.


    In order to complete this application, you will need a valid email address. All items marked with a star (*) are required fields.

  2. Contact Information
    Under state statute, commissioner's names, addresses and either a phone number or an electronic address where you can be reached are public information. All other personal information is private data and cannot be released to the public unless the commissioner gives permission for the city to release it. Information relating to a student representative is private data and will not be released.
  3. City of Roseville Commissions
    Human Rights, Inclusion and Engagement
    Parks and Recreation
    Police Civil Service
    Public Works, Environment and Transportation
  4. Note
    There is no character limit for the fields below.
  5. If you chose a 2nd preference, please also include your answer for that commission choice in your response.

  6. If you chose a 2nd preference, please also include your answer for that commission choice in your response.

  7. If you chose a 2nd preference, please also include your answer for that commission choice in your response.

  8. Preferred method to be contacted
    City staff contact all applicants approximately four days before the interviews to confirm interview date, time and location. Please indicate your preferred way to be notified.
  9. Demographics

    The City of Roseville seeks to increase diversity on volunteer commissions; diversity in terms of: racial, economic, age, gender, geographic, sexual orientation, ownership, disability and education attainment. Your answers on this form help us determine the success of our efforts and are not used in determining appointments to boards and commissions. Your information is kept strictly confidential and when reported, will not identify any individual.

  10. If yes, into which category does your disability fall? (Choose all that apply)*
  11. What is your employment status? (Check all that apply)*
  12. What is your race/ethnicity? (Check all that apply)*
  13. Additional Information if you become Board or Commission Member
    Additional information may be emailed to or delivered to Administration Department, City of Roseville, 2660 Civic Center Drive, Roseville, MN 55113 or faxed to 651-792-7020.
  14. Minnesota Government Data Practices Act*
    I understand that information provided in this application may be distributed by the City to the public including, but not limited to, being posted on the City of Roseville website. I agree to waive any and all claims under the Minnesota Government Data Practices Act, or any other applicable state and federal law, that in any way related to the dissemination to the public of information contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the information provided.
  15. Minnesota Statute §13.601. subd. 3(b)*
    Occasionally, City staff receive requests from the media or from the public for ways to contact Commission members. The Commission roster is periodically made available. Under Minnesota Statute §13.601. subd. 3(b), either a telephone or electronic mail address (or both) where you can be reached must be made available to the public. Please indicate which contact method the City may make available for inclusion on the Commission roster.
  16. Background Authorization*
    I understand that the Commission position for which I am applying may require the City of Roseville to perform a background check. As a result, an investigation may be made in which information is obtained through personal interview(s), information held by law enforcement or governmental agencies, present or former employers, financial institutions, or references I have provided. I understand that the City of Roseville will use the services of the Roseville Police Department to assist with the research and verification of the information I have provided on my application. The City of Roseville will utilize various sources of information it deems appropriate, including, but not limited to, credit reporting agencies, Department of Motor Vehicles records, criminal conviction records, current and former employers, military records, education records, and professional and personal references. I request, authorize and consent to the release and disclosure of any and all information, including, but not limited to, the above to the City of Roseville and the Roseville Police Department, and hereby expressly release any person who provides information pursuant to this investigation from any claims or liability by me or on my behalf.
  17. Acknowledgement*
    I have read and understand the statements on this form, and I hereby swear or affirm that the statements on this form are true.
  18. Leave This Blank:

  19. This field is not part of the form submission.

  1. Roseville MN Homepage

Contact Us

  1. Roseville City Hall

  2. 2660 Civic Center Drive

  3. Roseville, MN 55113

  4. Monday - Friday
    8:00 a.m. - 4:30 p.m.

  5. Phone: 651-792-7000

  6. Email Us

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