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

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.

The nominating committee shall make recommendations to the Leon County Board of County Commissioners for the six at-large members.

Members must be residents and electors of Leon County, or have their principal place of employment in the County.

Are you a resident of Leon County AND a registered voter in Leon County?

Yes

Is your principal place of employment in Leon County?

Yes

Members on this Authority 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

The Leon County R&D Authority (LCRDA) Board of Governors has expressed the preference that, whenever possible, its officers (Chair, Vice Chair, and Treasurer) be elected from the pool of six at-large members. In some instances, at-large Board members may need to serve as officers for as many as three years of their four-year terms. Officers, along with the immediate past Chair, serve on the Executive Committee. The Treasurer serves as Chair of the Budget Committee, member of the Investment Advisory Committee, and attends Audit Committee meetings. All members may be asked to volunteer to serve on other committees as needed (e.g., procurement evaluation committees).
Meeting Frequency:
Board of Governors - First Thursday of every even numbered month.
Executive Committee - Monthly as needed
Budget Committee - September (one time per year)
Audit Committee - November and January (two times per year)
Investment Advisory - November (one time per year)

Officer duties are more fully described in the LCRDA Bylaws. Officers are fully supported by the LCRDA staff in preparation of all required documents, agendas, meeting reports and financial reports.

I understand that I will be asked to serve as an officer on a subcommittee and agree to serve.

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 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.