Fillable TOWN OF DAVIE 6591 Orange Drive Davie, Florida (Town of Davie)

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TOWN OF DAVIE 6591 Orange Drive Davie, Florida (Town of Davie)

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The TOWN OF DAVIE 6591 Orange Drive Davie, Florida (Town of Davie) form is 4 pages long and contains:

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  • 24 check-boxes
  • 18 other fields

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TOWN OF DAVIE
6591 Orange Drive
Davie, Florida 33314
www.davie-fl.gov
ADVISORY COMMITTEE/BOARD MEMBER APPLICATION
The Town of Davie is a public entity subject to Chapter 119 of the Florida Statutes concerning public records.
Please be advised that the information provided in this application is public record and therefore is subject to the
disclosure provisions of the Florida Statutes. If you are claiming exemption under Chap. 119, Fla. Stat., please
provide the category of exemption and proof to the Town Clerk.
LEGAL NAME:
First/Middle/Last
DATE OF BIRTH:
(MM/DD/YYYY)
VOTER’S REGISTRATION#:
CURRENT ADDRESS:
(Please provide full address to confirm Town residency. No P.O. Box address is permitted for vetting purposes.)
Street/City/State/Zip
BUSINESS NAME:
EMAIL
PHONE NUMBER
REQUIRED
Place Driver’s License here and then Copy
(APPLICANT’S SIGNATURE)
(DATE)
Page 1 of 5
Page 2 of 5
Criminal History
Have you ever been convicted of a crime?
Are there criminal charges pending against you?
If you answered yes to either of these questions, please describe the nature of the crime(s) or charge(s),
the date and place of the offense, and the legal disposition of the case:
The following will automatically disqualify you from becoming a volunteer:
• Conviction of any felony offense
At the discretion of the Town of Davie, the following may disqualify you
from becoming a volunteer:
•
A conviction of a misdemeanor
• Outstanding warrant for arrest or pending charges
Acknowledgements
As a committee/board member of the Town you are required to comply with Chapters 112, 119, and 286, Fla. Stat.
and Town of Davie Ordinance 2019-009 which requires committee/board members to receive training on Sunshine
Law, Public Records Law, Ethics and Robert’s Rules.
Please sign below acknowledging acceptance of these requirements.
_______________________________________
Some committee/boards are mandated by Chapter 112 Fla. Stat. to complete a “Statement of financial Interest (Form
1)” on an annual basis. The Town Clerk will notify the board/committee liaison of which individuals who are required to
file a Form 1.
Please sign below acknowledging acceptance of this requirement.
______________________________________
(Applicant's signature)
(Applicant's signature)
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Page 3 of 5
Applications are accepted annually. Membership is based on meeting the qualification requirements and
membership availability per committee/board.
Please select below the committee/board of interest:
Airport/Transportation Advisory Committee
Agricultural & Environmental Advisory Committee
Budget Advisory Committee
Charter Review Board
District Boundary Review Board
Historical Preservation Board
Planning and Zoning Board
Site Plan Committee
Planning and Zoning Board
United Ranches Preservation Committee
Unsafe Structures Board
Youth Education and Safety Advisory Committee
Page 4 of 5
You may use this form or another sheet of paper for your answers.
1. Briefly describe why you wish to serve on this advisory committee/board:
2. Describe your qualifications and/or skills which would benefit this advisory committee/board:
3. Describe your involvement in the Town of Davie Community:
4. Please state your current occupation:
5. List your educational and professional background and area of study(If you wish you may submit your
resume with this application):
6. Appointment to this committee/board will require your attendance at evening meetings. How many
hours per month are you willing to commit as a volunteer?
7. If you are not appointed to this committee/board at this time:
Do you wish to be considered for appointment to another advisory committee/board? Yes No
Do you wish to be considered for future appointment to this committee/board? Yes No
Would you be willing to volunteer for other Town activities? Yes No
8. All board/committee members must have an established domicile in the Town of Davie or be a Davie
business over with a Business Tax Receipt (BTR) in good standing.
Are you a resident of the Town of Davie? Yes No
Are you a Town of Davie business owner Yes No
9. Town advisory committees/boards have a 2-year term.
Are you willing to commit for this length of time? Yes No
Page 5 of 5
INSTRUCTIONS:
1. MUST HAVE COPY OF ID
(Acceptable ID’s: Driver’s License, Military ID or Passport)
2. MUST SHOW PROOF OF RESIDENCY OR BUSINESS OWNERSHIP (WITHIN TOWN
LIMITS) (Acceptable ID’s: Copy of voter registration card, and driver’s license. Business Owners
must include copies of: voter’s registration card, driver license, articles of organization (sunbiz.org), and
Business Tax Receipt)
3. Return all paperwork to:
Office of the Town Clerk
Attn: Evelyn Roig
6591 Orange Drive
Davie, Florida 33314
Telephone: (954) 797-1011
Facsimile: (954) 797-1087
Evelyn_roig@davie-fl.gov
THIS APPLICATION DOES NOT OBLIGATE THE TOWN OF DAVIE TO ACCEPT THE SERVICES OF THE
APPLICANT. THE TOWN OF DAVIE RESERVES THE RIGHT TO CHANGE OR TERMINATE A VOLUNTEER
ASSIGNMENT.
Applicants vetted through the screening process will be added to a list for Town Council consideration.
Special Accommodations: If you require any special accomodations please contact the Town
Clerk at
(954)797-1023.
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TOWN OF DAVIE 6591 Orange Drive Davie, Florida (Town of Davie)

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Completed 18 January 2021

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