Mayoral Boards and Commission Application

Name:

Residential Address:

ZIP code:

Gender (optional):

MaleFemaleNon Binary

Describe yourself within one or more of the categories. This information is requested pursuant to Section 760.80, Florida Statutes.:
Access the Statute online.

Caucasian
African American
Hispanic American
Asian American
Native American
American woman
Physically Disabled

I am a U.S. citizen.:

YesNo

Email address:

Have you ever been elected to any public office in Florida? If yes, please provide the office title, date of election, term of office, and level of government:

Have you previously been appointed to any office that required confirmation by the Jacksonville City Council? If yes, please provide the office title and term of appointment:

Are you a registered voter in Florida:

YesNo

If yes, please identify which county:

Please identify which board(s) and/or commission(s) on which you want to serve:

Are you (or your spouse or child) employed by, or an officer of, an entity doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?:

YesNo

Do you, your spouse, or your child own a business that is doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?:

YesNo

Do you engage in any consulting or contract work with a business that is doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?:

YesNo

Are you (your spouse or child) a member (voting or non-voting) of any nonprofit or corporate boards that are doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?:

YesNo

Please attach a copy of your resume and/or bio.:

City of Jacksonville

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