Home Vacancies Committee Application Orientation FAQ | Contact Us Citizen Committees Application for Appointment Leon County Board of County CommissionersCitizen Committees Application for Appointment Personal Information(* indicates required field) First Name* Middle Name Last Name* Title* -- Select Title -- Mr. Ms. Mrs. Dr. DOB (MMDD only)* DOBDD Phone* Email* Confirm Email Address* Address Line 1* Address Line 2 City* State* -- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Colombia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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 Address Line 1 Address Line 2 City State -- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Colombia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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 -- Select District -- District I District II District III District IV District V Gender Male Female Disabled No 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. Have you completed the Applicant Orientation for membership on Citizen Committees, Board & Authorities?* Yes No Your application will only be considered if you have completed the online orientation. Are you currently serving on a County Advisory Committee or other Committee/Authority/Board?* Yes No If yes, on what Committee(s) are you a member? Have you served on any previous Leon County committees?* Yes No If Yes, on what Committee(s) have you served? Are you willing to complete a financial disclosure if applicable?* Yes No Your application will only be considered for those committees/boards/authorities that do not require members to complete the Financial Disclosure Form 1. 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)* Yes No If yes, please explain Are you or your employer, or your spouse or child or their employers, currently doing business with Leon County?* Yes No If yes, please explain 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?* Yes No If yes, please explain. 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?)* Yes No If yes, please explain Do you foresee participating in any competitive bid process for Leon County business during your time serving on this committee/board/authority?* Yes No If yes, prior to or at the time of submission of any bid for county business, a Florida Commission on Ethics Form 3A must be filed. 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?* Yes No If yes, prior to or at the time of submission of any bid for Committee/Board/Authority business, a Florida Commission on Ethics Form 3A must be filed. Please select the committee that you are interested in serving on. -- Select Committee -- Advisory Committee for Quality Growth Affordable Housing Advisory Committee Animal Shelter Advisory Board Architectural Review Board Audit Advisory Committee Big Bend Health Council, Inc. Board of Adjustment and Appeals Canopy Roads Citizens Committee CareerSource Capital Region Board Code Enforcement Board Community Development Block Grant Citizens Advisory Task Force Contractors Licensing and Examination Board Council on Culture and Arts Early Learning Coalition of the Big Bend Region Housing Finance Authority of Leon County Investment Oversight Committee Joint City/County Bicycling Workgroup Joint School Coordinating Committee Leon County Educational Facilities Authority Leon County Research and Development Authority Library Advisory Board Planning Commission Science Advisory Committee Tallahassee Sports Council Tallahassee-Leon County Commission on the Status of Women & Girls TLC Minority, Women, & Small Business Enterprise Citizen Advisory Committee Tourist Development Council Value Adjustment Board Water Resources Committee Members must be voters registered in Leon County Are you a registered voter in Leon County? Yes No You are not eligible to serve on the Contractors License and Examination Board. Members must meet one of the membership eligibility criteria as listed below. Please indicate your area of expertise. Please check all that apply. Architect Engineer Business person General contractor or other contractor (building & residential) who is registered or certified under Section 489.105(3)(a) (c). F.S. Pool/spa contractor or other contractor (sheet metal, roofing, air conditioning, mechanical, plumbing, excavation or solar) who is registered or certified under Section 489.105(3)(d) (o). F.S. Consumer representative who is not, and has never been, a member or practitioner of a profession regulated by the Contractors Licensing and Examination Board or a member of any closely related profession. All members of the board, except for the consumer representatives, shall be licensed in this State and actively engaged in the profession they represent on the Board Are you licensed in the state of Florida and actively engaged in that licensed profession? Yes No 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. Electronic Signature Submit Application Application Submitted Successfully Your application was submitted successfully. A copy has been provided for your records. Click here to download a copy to save and keep for your records. Would you like to take a moment to submit an application for a second committee? You will only need to answer the committee questionnaire. }
