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. Quality of Life Advisory Board
   4. Intergovernmental Appointments**
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.
   **To boards such as River to Sea Citizens' Advisory Committee, Volusia Growth Management Commission, etc.

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 386-676-3331.
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