Personal Information

(* indicates required field)

   
   
   
   
Employment Information


Resume and References

First Reference

(you must provide at least one personal reference who is not a family member)

Second Reference
 

 

  

If no resume is available, in the space below briefly describe or list the following: any previous experience on other Committees; your educational background; your skills and experience you could contribute to a Committee; any of your professional licenses and/or designations and indicate how long you have held them and whether they are effective in Leon County; any charitable or community activities in which you participate; and reasons for your choice of the Committee indicated on this Application. Please attach your resume, if one is available.

Diversity

(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.
     --   Leon County Property Appraiser

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.

Committee Questionnaire

(* indicates required field)

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.

Have you completed the Applicant Orientation for membership on Citizen Committees, Board & Authorities?
Are you currently serving on a County Advisory Committee?
Have you served on any previous Leon County committees?
Are you willing to complete a financial disclosure if applicable?
Do you know of any circumstances that would result in you having to abstain from voting on a Committee/Board/Authority due to voting conflicts? (Not applicable to Focus Groups)
Are you or your employer, or your spouse or child or their employers, currently doing business with Leon County?
Are you or your employer, or your spouse or child or their employers, currently doing business with the Committee/Board/Authority to which you are applying for membership?
Do you currently have any employment or contractual relationship that would create a continuing or frequently recurring conflict with regard to your participation on a Committee/Board/Authority? (i.e. would you have frequent or reoccurring voting conflicts?)
Do you foresee participating in any competitive bid process for Leon County business during your time serving on this committee/board/authority?
Do you foresee participating in any competitive bid process involving business with the Committee/Board/Authority to which you are applying, during your time serving on that entity?
Members must be electors of Leon County.
Are you registered to vote in Leon County?
Members must represent one of the following categories.
Please check all that apply.

Upon checking this box, I electronically sign my application and certify that all statements and information provided in this application are true to the best of my knowledge.

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 Email: SmachM@LeonCountyFL.gov Applications will be discarded if no appointment is made after two years.