Jacksonville.gov - Mayoral Boards and Commission Application

Name

Residential Address

ZIP code

Gender (optional)

Male Female Non Binary

Describe yourself within one or more of the categories

Caucasian African American Hispanic American Asian American Native American American woman Physically Disabled

This information is requested pursuant to Section 760.80, Florida Statutes.

I am a U.S. citizen

Yes No

Email

Have you ever been elected to any public office in Florida?

If yes, please provide the office title, date of election, term of office, and level of government

Have you previously been appointed to any office that required confirmation by the Jacksonville City Council?

If yes, please provide the office title and term of appointment

Are you a registered voter in Florida?

Yes No

If yes, please identify which county

Please identify which board(s) and/or commission(s) on which you want to serve

Are you (or your spouse or child) employed by, or an officer of, an entity doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?

Yes No

Do you, your spouse, or your child own a business that is doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?

Yes No

Do you engage in any consulting or contract work with a business that is doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?

Yes No

Are you (your spouse or child) a member (voting or non-voting) of any nonprofit or corporate boards that are doing business with, or receiving funds from, the City of Jacksonville (including independent authorities)?

Yes No

Please attach a copy of your resume and/or bio

Select a file

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