CITY OF NORTH LAUDERDALE

APPLICATION FOR APPOINTMENT

CITY BOARDS/COMMITTEES

In order to assist the City Commission in making Municipal Board/Committee Appointments, please complete the following information, attach a resume, and return this form to the City Clerk.

NAME DATE

HOME ADDRESS

HOME PHONE

BUSINESS

BUSINESS ADDRESS

BUSINESS PHONE

ARE YOU A CITY RESIDENT? YES IF YES, HOW LONG: NO

ARE YOU A REGISTERED BROWARD COUNTY VOTER? YES NO

PREVIOUS RESIDENCE ADDRESS:

ARE YOU A CITIZEN OF THE UNITED STATES? YES NO

AGE: UNDER 21 21-35 35-50 OVER 50

PLEASE CHECK THE BOARD(S)/COMMITTEE(S) IN WHICH YOU ARE INTERESTED AND NUMBER BY PREFERENCE (IF ANY):

PLANNING & ZONING BOARD* CODE ENFORCEMENT BOARD*

COMMUNITY IMPROVEMENT CIVIL SERVICE BOARD*

COMMISSION*

ECONOMIC DEVELOPMENT BOARD

CHARTER REVIEW BOARD

PARKS & RECREATION BOARD PUBLIC HOUSING AUTHORITY

MULTI-CULTURAL COMMITTEE

*Financial Disclosure Form is required for these Boards

AFFILIATIONS WITH CIVIC/PUBLIC SERVICE ORGANIZATIONS:

NORTH LAUDERDALE YEARS OFFICE HELD (IF ANY)

OUTSIDE OF CITY YEARS OFFICE HELD (IF ANY)

PLEASE LIST YOUR BACKGROUND, EXPERIENCE, EDUCATION, ETC. WHICH WOULD QUALIFY YOU TO SERVE ON A BOARD/COMMITTEE.

EDUCATION

EMPLOYMENT HISTORY

OCCUPATION OR POSITION

YEARS OF SERVICE

DUTIES

QUALIFICATIONS: (Briefly describe the specific expertise and/or abilities which you can contribute)

WHY DO YOU WISH TO SERVE AS A BOARD/COMMITTEE MEMBER?

HOBBIES/INTERESTS:

ACKNOWLEDGEMENT: I understand that in accordance with the Florida Sunshine Law, Chapter 286, Florida Statutes, as amended from time to time, the above-referenced information is a matter of public record. I understand that the appointment is for voluntary, uncompensated service. If appointed, I agree to faithfully and fully perform the duties of my office, will make every endeavor to serve my full term, and will comply with all laws and ordinances of the City, County and State of Florida, particularly those pertaining to the conduct of public officials and the financial disclosure requirements, if applicable to my position.

SIGNATURE DATE

· NOTES: Please attach a resume or brief biography. Application is effective for one year from date of completion.

· City policy requires regular attendance and proper notification to City Clerk when absence is necessary (excused by Chairperson). Failure to attend Board/Committee meetings may result in removal from the Board/Committee by the City Commission.

· Political party affiliation shall not determine board appointment.

· Making any false statements may be cause for removal from the Board/Committee by the City Commission.

· City Charter limits participation on Boards/Committees to persons 18 years of age or over.