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Advisory Board & Committee Interest Form
Leave This Blank:
Form must be filled out completely
Name
Date
Home Address
Zip Code
Home phone
Cell Phone
Email
Number of years as city resident
Owner or Renter
District #
Occupation
Business Name
Business Address
Work Phone
Fax
Education (highest degree / level)
Are you registered to vote in Broward County
Yes
No
Identify the board / committee(s) to which you request appointment (Please rank in order of preference)
(1)
(2)
(3)
(4)
Are you interested in serving on more than one board / committee?
Yes
No
If so, how many?
Please describe your professional and/or volunteer experience or background, which best qualifies you for selection to the board / committee
If you are applying for a board / committee, which has specific requirements / categories, please detail how your background and/or experience meets the required criteria.
Applicant must attend at least one board/committee meeting prior to consideration of application for every board applied. Please list board/committee meeting you attended in the last year.
Have you ever served on a city advisory board in the past?
Yes
No
If yes, please describe
Are you presently employed by the City of Hollywood?
Yes
No
If so, in what capacity?
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