2007 Killian f)
CITY OF BOYNTON BEACH
4, ADVISORY BOARD APPOINTMENT APPLICATION
Think you for your interest in serving on a City advisory board and for taking the time to fill out this form.
Zse print or type all answers clearly. If interest is expressed in appointment to more than one
, selections must be prioritized. If instructions are not followed or the application is not filled out in its
anfrety, the form will be returned for clarification.
Name ZgA/6,9-ee
K/ // /� Telephone # `rf 37- e
Address Z. 1 v I El VE E � Zip Code 3
E-mail Address:
Current occupation or, if retired,
prior occupation e a 1)--o r�
Education AIPA .j ' a — " _ _ .S C) 'es - i L j
i
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 11-No
Have you served on a City board in the past? Yes --111—No
If so, which board(s) and when?
Have you ever been convicted of a crime?
If so, when Ocl D where
false indicate (by number) to which advisory board(s) you are seeking appointment. You may serve on
Oily one board. Please do not check more than three boards. Prioritize your choices by number, 1 being
the most desired and 3 being the least preferable. For board requirements, responsibilities and meeting
times and dates, see the attached listing.
Arts Commission Firefighters'Pension Trust Fund
Building Board of Adjustment&Appeals Golf Course Advisory Committee
Cemetery Board library Board
Code Compliance Board / Planning &Development Board
Community Redevelopment Agency* Police Officers'Retirement Trust Fund
Community Relations Board Recreation&Parks Board
..�Education and Youth Advisory Board Senior Advisory Board
Employees'Pension Board Veterans Advisory Commission**
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*Resume required
*•List'ranch of Military Service or Organization on Reverse Side.
SNXIWP100AR Form-Talent Bank Form.doc Revised 1/11/2007 11,16 AM
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