Fillable Please choose the Board(s) for which you wish (City of Edgewater Florida)

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Please choose the Board(s) for which you wish (City of Edgewater Florida)

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CITY OF EDGEWATER
CITY CLERK’S OFFICE
104 North Riverside Drive
Edgewater, Florida 32132
cityclerk@cityofedgewater.org
Phone: (386) 424-2400 X 1102 FAX: (386) 424-2410
ADVISORY BOARD APPLICATION
Please choose the Board(s) for which you wish to apply. If applying for more than one Board, you must number in order of your
preference. * Please note - based on Council decision (08/03/2020) a background check will be completed on all board
applicants.
_____ City Manager Advisory Board _____ Environmental Advisory Board
_____ Library Board _____ Police Pension Board *
_____ Economic Development Board _____ Recreation & Cultural Services Board
_____ Charter Review Committee _____ Veterans Park Advisory Committee
_____ Planning & Zoning Board _____ Firefighters Pension Board *
_____ General Employee’s Pension Board *
Members of the Boards with an asterisk (*) are required to file a Financial Disclosure Form within 30 days of appointment.
PERSONAL INFORMATION
Name: ____________________________________________________________________________________
Address: _________________________________________________________________________________
Home Phone: _______________________________ Business/Cell Phone: _______________________
E-Mail Address: ___________________________________________________________________________
Occupation: _______________________________ Are you a resident of Edgewater? _____ how long _____
Is your principal place of employment in Edgewater? ______
Are you currently serving on a City Board? ______ Have you ever served on a City Board? _______
If yes, when and which Board? _______________________________________________________________
REFERENCES - Please list three business and/or personal
Name, address and phone
Name, address and phone
Name, address and phone
EDUCATION
Hig
h School _______________________________________________________________________________________________
College ___________________________________________________________________________________________________
Degree(s) __________________________________________________________________________________________________
WORK EXPERIENCE _____________________________________________________________________________________
_
_________________________________________________________________________________________________________
_
_________________________________________________________________________________________________________
I
NTERESTS/ACTIVITIES _________________________________________________________________________________
_
_________________________________________________________________________________________________________
_
_________________________________________________________________________________________________________
_
_________________________________________________________________________________________________________
CO
MMUNITY INVOLVEMENT ____________________________________________________________________________
_
_________________________________________________________________________________________________________
__________________________________________________________________________________________________________
_
_________________________________________________________________________________________________________
WHY DO YOU DESIRE TO SERVE ON THIS/THESE BOARDS? _______________________________________________
_
_________________________________________________________________________________________________________
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_________________________________________________________________________________________________________
__________________________________________________________________________________________________________
E
XPERIENCE/QUALIFICATIONS RELATED TO BOARD(S) APPLYING FOR __________________________________
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_________________________________________________________________________________________________________
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_________________________________________________________________________________________________________
A resume or separate sheet with additional information may be included with your application. Please return the
application to the City Clerk’s Office.
I
understand the responsibilities associated with being a board member, and I have adequate time to serve if appointed.
_
___________________________________________ ________________________________________________
Applicant Signature Date
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Completed 22 January 2021

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