Citizen Committees Application for Appointment - Advisory Boards and Committees

Leon County Board of County Commissioners
Citizen Committees Application for Appointment

Personal Information

(* indicates required field)

First Name*

Middle Name

Last Name*

Title*

DOB (MMDD only)*

DOBDD

Phone*

Email*

Confirm Email Address*

Address Line 1*

Address Line 2

City*

State*

Zip Code*

*Note: Your address will be used to verify County Residency

Do you live in Leon County?*

Yes No

Do you live within the City limits?*

Yes No

Do you own property in Leon County?*

Yes No

Do you own property in the Tallahassee City Limits?*

Yes No

How many years have you lived in Leon County?*

Employment Information

Employer*

Occupation*

Work or Other Phone

Extension

Work Email

Address Line 1

Address Line 2

City

State

Zip Code

Resume and References

First Reference

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

Name*

Telephone*

Extension

Address*

Second Reference

Name

Telephone

Extension

Address

Please attach your resume

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.

Race

White

Black or African American

Asian

Hispanic or Latino

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Age

District -- Leon County Property Appraiser

Gender

Male

Female

Disabled

Yes

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.

Please select the committee that you are interested in serving on.

Members on this Board must be a Leon County resident or Leon County property owner.

ARB members must represent one of the membership eligibility criteria as listed below. Please indicate which category you represent.

Please check all that apply.

Owner of property zoned with Historic Preservation Overlay (HPO).

Member of American Institute of Architects

Member of Tallahassee Trust for Historic Preservation, Inc.

Members on this board must file a Financial Disclosure Form #1 from the Florida Commission on Ethics, per State Statute 112.3145. Financial Disclosure Information - Ethics.

Are you willing to file a Financial Disclosure Form?

Yes

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 Lisa Davis telephone at 606-5300 or by Email: DavisLis@leoncountyfl.gov Applications will be discarded if no appointment is made after two years.