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)

_______________________________________________________________________________________________________


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.)

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________


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

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________


WHAT CAN YOU CONTRIBUTE TO THIS BOARD:

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________


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.