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Advisory Board/Committee Application

  1. This application is intended to provide information that will enable the City Commission to select the most qualified Board/Committee members. Please complete all applicable sections and return the form along with your current résumé to the City Clerk’s Office.
  2. City of Fernandina Beach
    City Clerk’s Office
    204 Ash Street
    Fernandina Beach, FL 32034
    (904) 310-3115

  3. Please note that board materials are distributed electronically.

  4. Eligibility

  5. Are you a resident of the City?
  6. Do you hold a public office?
  7. Are you employed by the City?
  8. Are you currently serving on a Board?
  9. Potential Conflict of Interest:
  10. Have you ever been engaged in the management/ownership of any business enterprise that has a financial interest with the City of Fernandina Beach?

  11. Major Affiliations:
  12. Qualifications:
  13. Educational Background: (Check all that apply)
  14. Florida’s Public Records Law, Chapter 119, Florida Statutes, states:
  15. “It is the policy of this state that all state, county, and municipal records shall at all times be open for a personal inspection by any person.” Your application when filed will become a public record and subject to the above statute. In addition, any appointed member of a board of any political subdivision (except members of solely advisory bodies) and all members of bodies exercising planning or zoning, are required to file a financial disclosure form (Form1) within 30 days after appointment and annually thereafter, for the duration of the appointment as required by Chapter 112, Florida Statutes
  16. I understand that if I am appointed to one of the City’s boards, I will be required to file a financial disclosure form - Form 1, as described above, and I am willing to comply with this requirement.

  17. I understand that any false, incomplete or misleading information given by me on the application is sufficient cause for rejection of this application. I understand and agree that any such false, incomplete or misleading information discovered on this application at any time after appointment to a Board may result in my removal.

  18. I also understand that all board appointments are for voluntary, uncompensated services. Additionally, if appointed, I am able to attend meetings and otherwise fulfill the duties of the office.

  19. Applications are submitted to the City Commission when vacancies occur and are effective for two years from date of completion.
  20. Do you understand the duties and responsibilities of the Board/Committee that you are applying for?

  21. By submitting this form, I declare the foregoing facts to be true, correct, and complete.
  22. Leave This Blank:

  23. This field is not part of the form submission.