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Advisory Committee Application for Board Appointment

It is the applicant’s responsibility to keep the information on this form current.

To advise the County of any changes please contact Mary Smach by telephone at 606-5300 or by e-mail at SmachM@leoncountyfl.gov

Applications will be discarded if no appointment is made after two years.

Required fields are indicated in Bold Italic.

 

   

     

 

Please select a preferred mailing address


Work Address

Home Address (Required to determine County residency)






Please select a least one committee that you are interested in serving on.

 



(OPTIONAL) Leon County strives to meet its goals, and those contained in various federal and state laws, of maintaining a membership in its Advisory Committees that reflects the diversity of the community. Although strictly optional for Applicant, the following information is needed to meet reporting requirements and attain those goals.

Race:



Sex:

Disabled?

In accordance with Section 286.26, Florida Statutes, persons needing a special accommodation to participate in the committee should contact the ADA Coordinator at 850-606-5011, or Facilities Management, 850-606-5000, by written or oral request at least 48 hours prior to the proceeding. 7-1-1 (TDD and Voice), via Florida Relay Service. Accommodation Request Forms are available on the website www.LeonCountyFl.gov/ADA.

Please attach your resume:


References (you must provide at least one personal reference who is not a family member):
First Reference:
 
 
 
Second Reference:


IMPORTANT LEGAL REQUIREMENTS FOR COMMITTEE/BOARD/AUTHORITY MEMBERSHIP
Citizen participation is important in developing Leon County's programs and policies, and in providing quality public services to the community. We appreciate your interest in serving on a committee and would like to bring a few items to your attention. As a member of a committee/board/authority, you will be obligated to follow any applicable laws regarding government-in-the-sunshine, code of ethics for public officers, and public records disclosure. The consequences for violating these applicable laws include criminal penalties, civil fines, and the voiding of any committee/board/authority action and of any subsequent action by the Board of County Commissioners.

In order to be familiar with these laws and to assist you in answering the following questions, please take a few minutes to complete the mandatory orientation. Your application will not be deemed complete until you have completed the orientation. 

CLICK HERE FOR THE ORIENTATION.

Please complete the online orientation prior to completing the following questions:







All statements and information provided in this application are true to the best of my knowledge.