Application for Advisory Board & Committees

Lake County Government Board of County Commissioners

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Application for Advisory Board/Committee

Fill out the below form to submit a general application for a Lake County Advisory Board/Committee. Printable application forms are also available.

General Application

Name
 
Home Mailing Address
 
Home Mailing City
 
Home Mailing Zip
 
Home Physical Address
 
Home Physical City
 
Home Physical Zip
 
County of Residence
 
Home Phone
 
E-mail Address
Education
Business Name & Type
Business Position
Business Address
Business City
Business Zip
Business Phone
Training, experience or qualifications related to board/committee to which appointment is sought:
State reasons you are interested in appointment which is sought:
Do you currently serve on a Lake County Board/Committee?

                                YesNo  
                            	
                                	If yes, please identify each board/committee:
                                
Have you served on a Lake County Board(s)/Committee(s) in the past?
YesNo  
Please identify those that you have served on, including the dates you served:

Please check Board(s)/Committee(s) that interest you.

                            	Affordable Housing Advisory Committee 
Board of Adjustment 
Board of Building Examiners   - Separate application is required for Board of Building Examiners
Capital Facilities Advisory Committee (formerly Impact Fee Committee)
Children's Services Council
Elder Affairs Coordinating Council
Enterprise Zone Development Agency - Local chamber of commerce representative
                                
                                Local financial or insurance entity representative
Local business representative
Business operating withint Nominated Area
Resident residing within the Nominated Area
Non-profit community-based organization operating within the Nominated Area
Regional workforce board representative
Local code enforcement agency representative
Local law enforcement agency representative
                                 
                                 Lake-Sumter MPO - Bicycle & Pedestrian Advisory Committee (BPAC)
Lake-Sumter MPO - Citizens' Advisory Committee (CAC)
Library Advisory Board
Mt. Plymouth-Sorrento Community Redevelopment Advisory Committee
                                
                                Property owner within Planning Area
Resident or property owner within a three mile radius of the Planning Area
                                     
                                     Which of the following do you have experience in? Please check all that apply:
	
                                     Land Planning
Engineering
Architecture
Ownership or operation of a business
Community leadership/volunteerism
                                     
                                 Parks, Recreation and Trails Advisory Board
Planning & Zoning Board
Public Safety Coordinating Council
Sales Surtax Oversight Advisory Committee
Tourist Development Council
Value Adjustment Board

                                Other:                                
                            
                                I will attend meetings in accordance with the adopted policies of Lake County. If at any time my business 
                                or professional interests conflict with the interests of this Board or committee, I will not participate
                                 in such deliberations. References may be secured from the following individuals: (Include Name, Address, Phone)

                                    	1. Name: 
                                    
                            			Address: 
                                	
                                    	Phone: 
                                    
                                    2. Name: 

                                    	Address: 

                                    	Phone: 

                                    	3. Name: 
                                    
                                    	Address: 
                                    
                                    	Phone:

In completing this application, you are acknowledging that personal information you provide is subject to Florida's Public Records Policy as stated in Chapter 119, Florida Statutes, and Article I, Section 24 of the State Constitution.

How did you learn of this vacancy?

Due to Florida laws regarding dual office holding, citizens cannot serve on more than one of the following boards at one time: Board of Adjustment, Board of Building Examiners, the Enterprise Zone Development Agency, the Planning & Zoning Board. In the event this occurs, the member will be required to resign from one of the positions.

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