Minnesota > Local County > Hennepin > District Court > Civil
Commissioner Application Form - Minnesota
| Commissioner Application Form Form. This is a Minnesota form and can be used in Civil District Court Hennepin Local County . |
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STATE OF MINNESOTA COUNTY OF HENNEPIN DISTRICT COURT FOURTH JUDICIAL DISTRICT COMMISSIONER APPLICATION FORM Real Estate Broker Certified Appraiser Registered Attorney Name: ____________________________________________________________________________________ Firm Name: _______________________________________________________________________________ Home Address: _____________________________________________________________________________ Business Address: __________________________________________________________________________ Home Phone: ____________________________ Work Phone: ___________________________________ Please list current professional licenses, registrations or certificates related to this job and list the type and license/registration number(s): __________________________________________________________________________________________ __________________________________________________________________________________________ Professional Affiliations/Partnerships: __________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Judicial Appointments as Commissioner (List case name, file number and judge under whom appointed): __________________________________________________________________________________________ __________________________________________________________________________________________ Professional Experience: _____________________________________________________________________ __________________________________________________________________________________________ Are you a Hennepin County resident? Yes No Do you own real estate in Hennepin County? Yes No If you answered YES to owning real estate in Hennepin County, please list: _____________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Educational Background (Name of college, university, technical, professional, business, etc. and the degree achieved): __________________________________________________________________________________________ __________________________________________________________________________________________ Government Positions Held (past and present): ______________________________________________________ __________________________________________________________________________________________ Last Revised 4/26/11 1 American LegalNet, Inc. www.FormsWorkFlow.com COMMISSIONER APPLICATION FORM CONFIDENTIAL/OPTIONAL INFORMATION (Available to Appointing Judge Only) Name: ________________________________ Social Security Number: ___________________________ Affiliated Financial Institutions: _______________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Clients: ___________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Please list three character references (non-related) that specifically apply to this position: Name Address City/State/Zip Telephone_______________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ I declare that any state in this application or information provided is true and complete and hereby acknowledge that I have read and understand the information below. Date: ________________________ __________________________________________ Signature (do not print) The state has the right to verify information provided in this application. False information may subject an applicant to the penalty provisions of M.S. ยง43A.39. In connection with this application for employment, I authorize the State of Minnesota and any agent acting on its behalf to conduct an inquiry into any job-related information contained in this application, including, but not limited to, my records maintained by an educational institution relating to academic performance such as transcripts. Moreover, I hereby release the State of Minnesota and any agent acting on its behalf from all liability of whatsoever nature by reason of requesting such information from any person. Please submit application to: Hennepin County District Court Administration Attn: Kellie Van Slyke MC 332 Government Center 300 South Sixth Street Minneapolis MN 55487-0332 612/348-6739 Last Revised 4/26/11 2 American LegalNet, Inc. www.FormsWorkFlow.com
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