APPLICATION FOR BOARD MEMBERSHIP

NAME: ______________________________________________________________________________________________ 

ADDRESS:___________________________________________________________________________________________

HOME PHONE: _____________________     BUS. PHONE:  _____________________    CELL:  _____________________

EMAIL:                                                                                                                                                      I WOULD LIKE TO BE CONSIDERED FOR MEMBERSHIP ON THE FOLLOWING CITY BOARDS / COMMITTEES - Rank your first choice by placing "1" in the box to the left. If you would consider an alternative appointment, if not appointed to the 1st choice, please place a "2" and so on to the left of the alternative Boards/Committees.

______       BOARD OF ADJUSTMENT, CODE ENFORCEMENT, AND APPEALS
                   Five (5) member board - 3 year term - No residency requirement. Suggested background: Engineer, Architect,                                      Building Contractor, Electric Contractor, Home Inspector, Plumbing Contractor, and/or Mechanical Contractor.

______      PLANNING COMMISSION
                  Seven member (7) and two (2) alternate member board - 3 year term - Majority of membership must be City residents.                     Others may be residents of Pasco County.

______      LIBRARY BOARD
                   Five (5) member board - 3 year term - No residency requirement, must be a patron of Library.

______      AIRPORT AUTHORITY
                  Seven (7) member board - 3 year term - May live outside of City; suggested background is in an aviation related                                    business, club or activity.

______     HISTORIC PRESERVATION BOARD
                 Five (5) member board - 3 year term - Must live in the City. Preference: Interest or background in Architecture, local                              history, building contracting and/or community planning.

______     PARKS & RECREATION ADVISORY BOARD
                 Seven (7) member board - 3 year term - Must be a Pasco County resident.

______      MAYOR'S YOUTH COUNCIL
                  Seven (7) member board - 2 year term, except that of the seven members first appointed, three shall serve for a term                          of seven months, four shall serve for a term of one year and seven months. The members will be Zephyrhills area                                   residents who are actively enrolled in a public, private high school, or home schooled in grades nine through                                              twelve. 

PLEASE ANSWER THE FOLLOWING:

ARE YOU A REGISTERED VOTER?   YES    NO                                PROPERTY OWNER?     YES         NO

WHY DO YOU WISH TO SERVE ON THIS CITY BOARD/COMMITTEE? (Please let us know why you are applying)

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WHAT IS IT IN YOUR BACKGROUND THAT HAS PREPARED YOU FOR THIS VOLUNTEER ROLE? (education, other boards you have served on, where you are employed, your job, interests, hobbies, etc.)

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DO YOU NOW OR HAVE YOU EVER SERVED ON A GOVERNMENT APPOINTED BOARD OR COMMITTEE? IF SO,WHERE AND UNDER WHAT CIRCUMSTANCES?

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WHAT CAN YOU CONTRIBUTE TO THIS BOARD:

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Sign:                                                                                        

Date:                                                                                      

You may submit this form via email: cityclerk@ci.zephyrhills.fl.us or print and fax to:
 Attn.: City Clerk (813) 780.0005.