Board Application eff 10/23/19 (D
CITY OF BOYNTON BEACH
ADVISORY BOARD APPOINTMENT APPLICATION
Thank you for your interest in serving on a City advisory board and for taking the time to fill out this form.
Please print or type all answers clearly. If interest is expressed in appointment to more than one
board, selections must be prioritized. If instructions are not followed or the application is not filled out in its
entirety, the form will be returned for clarification.
Name Telephone #
Address
Zip Code
Other
E-mail Address: Phone:
Current occupation or prior occupation:
Education
Are you a registered voter? Yes No
Do you reside within the Boynton Beach City limits? Yes No
Do you own/manage a business within the City limits: Yes No
If"yes", name of business
Are you currently serving on a City board? Yes No
Have you served on a City board in the past? Yes No
If so, which board(s) and when?
Have you ever been convicted of a crime?
If so, when Where
Please indicate which advisory board you are seeking appointment. For board listing, requirements, responsibilities
and meeting times and dates, see pages 3 and 4 attached.
Arts Commission Historic Resources Preservation Board
Building Board of Adjustment&Appeals Library Board
Community Redevelopment Agency Advisory Board Planning & Development Board
Education and Youth Advisory Board Police Officers'Retirement Trust Fund
Employees' Pension Board Recreation & Parks Board
Firefighters' Pension Trust Fund Senior Advisory Board
Golf Course Advisory Committee
S:\CC\WP\BOARDS\Applications\Master Form -Talent Bank Form- REVISED 10-01-18.doc
Revised: 10/1/18
What personal qualifications do you possess (i.e., profession, previous experience, branch of military service
or organization) which you feel would make you a good candidate for this board? Please be specific.
Please list any professional memberships:
Feel free to attach an extra sheet or resume. Return the completed form to the City Clerk's Office, 3301
Quantum Blvd, Ste. 101. or Mailing address: P. O. Box 310, Boynton Beach, FL 33425-0310. It will be
placed in the City's Talent Bank, a file to which Commissioners may turn for candidates when board
openings occur.
I hereby certify that the statements and answers provided herein are true and accurate. I understand that,
if appointed, any false statements may be cause for removal from a board.
Signature: Date:
S:\CC\WP\BOARDS\Applications\Master Form -Talent Bank Form- REVISED 10-01-18.doc
Revised: 10/1/18