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Application for Board Membership
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 RESIDENT OF THE CITY? | YES | NO | HOW LONG? |
ARE YOU A RESIDENT OF THE COUNTY? | YES | NO | HOW LONG? |
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.