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 or experience related to activities of boards or committees to which appointment is sought:

Professional organizations you belong to:

Have you served on a Lake County Board(s)/Committee(s) in the past?

Yes
No

Please identify those that you have served on, including the dates you served:

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

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?

Newspaper Ad
Internet
Friend
Other

Applications are kept on file with the Board of County Commissioners for a period of one year from date of receipt. Should a vacancy occur and you are not appointed to a particular board/committee, your application may be reconsidered should another vacancy occur during that one year period.

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