03-939CouncIl File # � � q
Green Sheet # � ��� 35
Presented By
Referred To
RESOLUTION
CITY OF SAINT PAUL, NIlNNESOTA �
Comxnittee: Date
1 RESOLVED, that the Saint Paul City Council consents to and approves the appointment, made
2 by the Mayor, of the following individual to serve on the Joint City/County Health Services
3 Advisory Committee.
Jennifer Rauch - term expires June 24, 2004
3
B
Requested by Departrnent of.
By:
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Fom�.A�iproved by Ci Attome
By:
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Appr Mayor for Sub1nission to
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AdoptedbyCouncil: Date�/f-�ii�/�.'�l
Adoption Certified by Council Secretary
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� Green Sheet Green Sheet Green Sheet Green Sheet Green Sheet Green Sheet �
DepartmeM/offiee/eouneil: Date Initiated:
Mo -��s�� 15-0CT-03 Green Sheet NO: 3006735
Contart Person 8 Phone: ���QM Se�rt To Person Initial/Date
Kurt SChultz � 0 a r• ce
266-6590 pssign 1 a or'sOffice De artmentDir r
Must Be on Council f�enda by (Date): Number 2 • p� - A me
Y2-0CT-03 For
Routing 3 a or's O%ce Ma odAssistant
Order 4 uncil council
5
Total # of Signature Pages _(Clip All Locations for Signature)
Action Requested:
Approval of the appointment, made by the Mayor, of Jenuifer Raucky to seroe on the Joint City/County Health Services Advisory
Committee. Her term shall elcpire on June 24, 2004.
Recommendations: Approve (A) or Reject (R): Personal Service CoMrecks Must Mswer the Following Questions:
Planning Commission 1. Has this persortffirm ever worked under a contract £or this department?
CIB Committee Yes No
Civil Service Commission 2. Has this person/firm ever been a city employee?
Yes No
3. Dces this personffirm passess a skill not normalty possessed by any
current city employee?
Yes No
Explain all yes answers on separete sheet and attach to green sheet
Initiating Problem, Issues, Opportuniry (Who, What, When, Where, Why):
Advanqpes If Approvetl:
Disadvantas�es If Approved:
Disadvanqges If Not Approved:
Total Amount of CosURevenue Budgeted:
Trensaction:
FundinS� Source: ActiviN Number:
Fi nancial Information:
(Explain)
�3 �9 3°I
Application for Committee, Board, or Commission
Please return to Mark Engebretson
Mayor's Officc, Itoom 390 City Hali
I S West Kellogg Bivd., $aint Paul, MN 55102
Phane:651-266-5533 Fax:651-266-8513
7Le Minveso�a Qovcrnmeni Daia PtscUces Aet (Mianesota Stasu[es ChaDter 13J goveras �ha City's nse of chc
�nfozmaeiou conesined in this spplication. Some ofthc inFermaeion soughc in vhis aDDliea[ioa is private daea uadet the
ne�. T6e roqnested inJOrmsUOa wil7 be uscd by eha sppoiviing aneDOiiey co caay out [Le Ciiy's officisl apqoincmen[
responsibilitics. You sre noa 7equiced sa providn a¢y information. Howevuq failure io annwcx ihe appl �c�tioa quettions
may csuce �he sppoiniiag anthozisy co reject yoas appticsciou. TAe majoxity ef iums �onzaiaed in efiie syptiueion aro
pu6lic, in<luding oamq yddreas. employment, cicills, stuinins an1 eaperi<nec, ¢nd arc i6ceefor< a.silablc to a�yon<
reque5tiug i6 T6e r<mainiug i�ems on cAa app{iea�ion Posm are elnesifiod as ptiva[a T6e privstc daea is svailablt only to
you and Io och�r persons in ch� Ciry whu, bccauec of �v�rk assignmettts, �easongO�yTCqilirt atce6s (o [hc infoimd[iOn.
N am e .� Q�Y} R 1'�� I`.Yf 1.t.E^�F ►,
Home address ���� ��q � j�
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Telephones (P� � ' � � � '�( .
Pl<wc{ndydcAreaCoae� h
E-maii address
Planniitg District Council
Preferred niailing addreas
Occupation
Place of employment
Emp]oymcnt address
Commiftee(s) appliei
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City Gouncil Ward
55i1q
What skills/training or experience do you possess for the commiYtee(s) for which you seek
appointment? •
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Personal References
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Reasons for your interest in ihis particular committee ���t ��, (+,pg��� �� f
h���� . " � �
FTave you had previous contact with the committee for wbich you are making application?
If so, when, and under what circumstances?
In an attempt to ensure that committee ropzesentation reflects the makeup of onr community,
pFease check the bax applicabte to you. This information is strictly voluntary.
,�White (Ca¢easian) � Hispanic �Black (African-American)
� Asian or Pacific Islandcc � Amezican Indian or Alaskan Eakimo
� Male Female i� Dste of birth �qCj� ,
Disabled: � Yes No �
If specia3 accommodations aze needed, please specify
How did you hear about this opening? �,(_,i�� ���(.Q�"{'�, _
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