Advisory Board Interest Application

2. Please select the advisory board(s) for which you wish to be considered:*

   1. Aviation Advisory Board
   2. Board of Adjustment and Appeals*
   3. Budget Advisory Board
   4. Brownfield Advisory Board

   1. Citizens' Law Enforcement Advisory Board
   2. General Employees' Pension Fund*
   3. Historic Landmark Preservation Board
   4. Housing Authority

   1. Human Resources Board
   2. Leisure Services Advisory Board
   3. Municipal Firefighters' Pension Trust Fund*
   4. Municipal Police Officers' Pension Trust Fund*

   1. Neighborhood Improvement Advisory Board
   2. Planning Board*
   3. Public Works Advisory Board
   4. Quality of Life Advisory Board

4. ALL ADVISORY BOARDS ARE SUBJECT TO THE "SUNSHINE LAW." Advisory board members are required to be residents of the City of Ormond Beach, and are required to meet attendance requirements.

   *Members of these advisory boards are required to file a financial disclosure form within 30 days of appointment to the board.

   *Members of these advisory boards are required to file a financial disclosure form within 30 days of appointment to the board.

6. PERSONAL:

8. First Name:*

9. Last Name:*

11. Email Address:*

13. Home Address:*

15. City:*

16. State:*

17. Zip:*

19. Personal Phone:*

21. Work Address:

23. City:

24. State:

25. Zip:

27. Work Phone:

29. Present Occupation:

31. How long have you been a resident of Ormond Beach:*

32. How long have you lived in Volusia County:*

34. Are you currently serving on a City advisory board?*

    1. Yes
    2. No

35. Have you ever served on a City advisory board?*

    1. Yes
    2. No

37. If yes, which board(s)?

39. EDUCATION:

41. High School:

42. Date Graduated:

44. College:

45. Date Graduated:

47. Degree:

49. Other Training:

51. EXPERIENCE:

53. Company/Employer and type of business or area of experience:*

55. Company/Employer and type of business or area of experience:*

57. Company/Employer and type of business or area of experience:*

59. COMMUNITY INVOLVEMENT:

61. Please list civic, religious, fraternal, etc., affiliations (include organization name, activity, and dates):*

63. INTEREST:

65. Please provide a brief statement concerning your interest in advisory boards and your willingness to serve as a member. *

67. AVAILABILITY:

69. When would you be available for meetings:*

    1. Mornings
    2. Afternoons
    3. Evenings
    4. Weekends

70. Notes regarding availability:

72. CONFLICTS OF INTEREST:

74. Can you think of any situation that might constitute a conflict of interest if you are selected to serve on an advisory board on which you may be interested in serving?*

76. REFERENCES:

78. Please list three business or personal references:

80. First Name:

81. Last Name:

83. Occupation:

85. Personal Phone:

86. Work Phone:

88. Address:

90. First Name:

91. Last Name:

93. Occupation:

95. Personal Phone:

96. Work Phone:

98. Address:

100. First Name:

101. Last Name:

103. Occupation:

105. Personal Phone:

106. Work Phone:

108. Address:

110. If you have questions concerning the duties and responsibilities of any of the advisory boards, please contact the City Clerk at 386-676-3297.

Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit

* indicates a required field