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2. Name
3. Home Phone
5. Home Address
6. Business
8. Business Phone
9. Business Address
11. Email
13. Brief Resume of Education & Experience
15. Are you a registered voter?

    1. Yes
    2. No
16. Are you a resident of Lake Mary?

    1. Yes
    2. No
18. Do you own property in Lake Mary?

    1. Yes
    2. No
19. Do you hold a public office?

    1. Yes
    2. No
21. Have you ever served on a City Board in Lake Mary?

    1. Yes
    2. No
22. Are you employed by the City of Lake Mary?

    1. Yes
    2. No
24. Have you ever been convicted of a misdemeanor or felony, excluding civil traffic violations?

    1. Yes
    2. No
26. If Yes, please provide information.

    Note: DUIs and revoked licenses are not "civil traffic violations and must be reported.

28. Boards you are interested in

    1. Code Enforcement Board
    2. Elder Affairs
    3. Firefighter's Pension (Trustees)
    4. Historical Commission
    5. Parks and Recreation Advisory Board
    6. Planning and Zoning Board
    7. Police Pension Board (Trustees)

    Note: You will be required to file a financial disclosure form if you are applying to the Code Enforcement Board, Firefighter's Pension Board, Planning & Zoning Board or Police Pension Board

30. What qualifications do you bring to the Board(s) if appointed?
32. Disclaimer

    Pursuant to City Code, service on City boards is at the pleasure of the City Commission. Board members may be removed with or without cause upon motion and majority vote of the City Commission. Applicant, by his/her signature below, waives any right under F.S. Section 112.501 to removal for cause and a hearing before removal.

34. Signature*
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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