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2. 2023 Volunteer Board Appointment Application

   This Application Form is a PUBLIC RECORD under Chapter 119, Florida Statutes, and is open to public inspection.

4. If you are interested in serving on an appointed City Board, Commission or Committee, please complete this form in its entirety.
6. First Name*
7. Last Name*
9. Home Address*
   Street Address (No P.O. Boxes)
11. Suite or Apartment Number
13. City*
14. State*
15. Zip*
17. Primary Phone*
18. Email Address*
22. Employer
23. How Long
25. Business Address
    Street Address (No P.O. Boxes)
27. Suite or Apartment Number
29. City
30. State
31. Zip
33. Business Phone
34. Position/Occupation
38. Brief Summary of Education and Work Experience

    Please include highest level achieved and any degrees earned as well as any professional licenses or vocational certificates, etc.

40. Please check the Board(s) you are interested in serving on*

    1. Planning and Zoning Commission/Land Planning Agency (Meets 2nd Wednesday of Each Month at 6:30 p.m.)
    2. Police Officers’ and Firefighters’ Pension Board of Trustees (Meets Quarterly Each Year at 10:00 a.m.)
    3. Parks and Recreation Advisory Board (Meets 2nd Tuesday of Each Month at 6:30 p.m.)
    4. City Tree Advisory Committee (Meets Quarterly Each Year at 4:30 p.m.)
    5. Other (Please List in Box Below)
42. If 'Other' was Selected, Please List the Desired Board Here.
44. Please select the PRIMARY Board you wish to be considered for*
    -- Select One --Planning and Zoning Commission/Land Planning Agency (Meets 2nd Wednesday of Each Month at 6:30 p.m.)Police Officers’ and Firefighters’ Pension Board of Trustees (Meets Quarterly Each Year at 10:00 a.m.)Parks and Recreation Advisory Board (Meets 2nd Tuesday of Each Month at 6:30 p.m.)City Tree Advisory Committee (Meets Quarterly Each Year at 4:30 p.m.)

    NOTE: Members of the Planning and Zoning Commission/Land Planning Agency Board and the Police Officers’ and Firefighters’ Pension Board of Trustees Board are REQUIRED to file detailed Financial Disclosure Forms annually.

46. Are you a City of Casselberry resident?*
    -- Select One --YesNo

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47. If yes, how long have you been a resident?*
49. Are you a registered voter in Seminole County?*
    -- Select One --YesNo

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50. If yes, what is your Precinct Number?
52. Have you ever served on a City Board?*
    -- Select One --YesNo

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53. If yes, which Boards and when?
55. Are you employed by a government entity?*
    -- Select One --YesNo

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56. If yes, please provide the name of the entity.
58. Potential Conflict of Interest: Do you do business, or are you engaged in the management of any business enterprise that has a financial interest with the City of Casselberry?*
    -- Select One --YesNo

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59. If you answered yes, please give details, including the name of the enterprise, the nature of the business and the position you hold.
61. Do you own property in the City of Casselberry?*
    -- Select One --YesNo

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62. Are you currently serving on a City Board?*
    -- Select One --YesNo

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64. Community Involvement
66. Interests/Activities
68. Why do you desire to serve on this/these Board(s)?
70. A resume or a document with additional information you wish to provide may be uploaded, if you so desire, but is not required.
74. THIS APPLICATION IS ONLY EFFECTIVE UNTIL 12/31/2023. Please call, write or email the City Clerk’s Office to advise of any changes. Applications are submitted to the City Commission when vacancies occur throughout the year. If you are not selected by 12/31/2023, you will need to fill out a new application to be considered in 2024.
76. Board Members serve at the pleasure of the City Commission and may be removed with or without cause upon motion and majority vote of the City Commission. Your signature below waives any right under Florida Statutes Section 112.501 to removal for cause and a hearing before removal.
78. All Boards and their members must function in accordance with provisions of the City Charter, City Code and Florida Laws, including GOVERNMENT IN THE SUNSHINE and the requirement for financial disclosure for certain boards. I understand the responsibilities associated with being a Board member, and affirm that I have adequate time to serve on the above board(s).
80. CERTIFICATE OF APPLICANT: I hereby certify that all the statements made on this Volunteer Board Application Form are true and correct. I understand that any false statements or omissions from this Volunteer Board Application form may be cause for my application not to be considered by the City Commission.
84. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
86. Electronic Signature*

    1. I agree.
88. Signature*
89. Date*
    Date
91. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.
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93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit Submit and Print

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