Application for Board Membership

APPLICATION FOR BOARD MEMBERSHIP


NAME: ________________________________________________________________________________________________

ADDRESS: ____________________________________________________________________________________________

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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.