Brueggemeier T - HRA Application
Fridley Civic Campus
7071 University Ave N.E. Fridley, MN 55432
763-571-3450 | FAX: 763-571-1287 | FridleyMN.gov
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Name ___________________________________________________________________________________
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Address ___________________________________________________________________________________
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7235346585
Home Phone ____________________ Number of Years/Months Resident of Fridley___________
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Employer _______________________________________________ Work Phone ____________________
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Address ____________________________________________________________________________________
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Email ____________________________________________________________________________________
Please rank in order, the commissions on which you wish to serve. (Leave blank any Commissions
on which you do not wish to serve.)
3
_____ harter Commission
2
_____ Housing & Redevelopment Authority
_____ Planning Commission
____vironmental Quality & Energy
Parks & Recreation Commission
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Prior Experience on City Commissions, City Boards, etc.: ________________________________________
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________________________________________________________________________________________________________
________________________________________________________________________________________________________
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Work Experience: ___________________________________________________________________________________
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________________________________________________________________________________________________________
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________________________________________________________________________________________________________
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Civic, Professional and Community Activities: ____________________________________________________
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________________________________________________________________________________________________________
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Why do you want to be on a Fridley commission? _______________________________________________
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________________________________________________________________________________________________________
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________________________________________________________________________________________________________
What skills, strengths or abilities do you believe you will add to the commission?
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________________________________________________________________________________________________________
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________________________________________________________________________________________________________
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________________________________________________________________________________________________________
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Does your work require you to travel? ________________ How often? ___________________________
Additional Comments: ______________________________________________________________________________
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________________________________________________________________________________________________________
________________________________________________________________________________________________________
References (Optional):
Name Address Phone No.
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________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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____________________________________________________________ ___________________________________
Signature Date
The information provided by you on this application will be used to determine your suitability for
appointment to a City of Fridley commission. Participation as a commission member is strictly voluntary, and
you are not required by law to provide this information. If you do not furnish this information, however, the
City may have difficulty determining your suitability for appointment and contacting you. Under Minnesota
State statutes, only your name is considered public information upon appointment. Any other information
on this application is private data and will be accessible only to you, City staff or as provided for by Minnesota
statutes.
Please return the application to Roberta Collins,
City of Fridley, 7071 University Avenue N.E., Fridley, MN 55432.