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Application for Board/Committee Membership
Note:
Application will be kept on file for a period of two (2) years. Periodic telephone calls will be placed to inquire into your interest in appointment to the selected board or committee before submittal to the City Council.
Choose from the following:
Checkboxes
Checkbox Description
Checkboxes
Checkbox Description
Board of Adjustment
Board of Adjustment & Appeals
Business Development Committee
Citizens Advisory Committee
Citizens Recreation Advisory Board
Code Enforcement Board
Education Advisory Committee
Planning Commission
Retirement Board, Fire Employees
Retirement Board, General Employees
Retirement Board, Police Employees
The Rockledge Environmental Enhancement (TREE) Board
Community Redevelopment Agency Board of Commissioners
Please provide the following information:
Field Description
Field Data
Required Field
Name:
required
Email:
required
Address:
City:
State:
Zip:
Phone:
Cell Phone:
Employer or Business:
Business Phone:
Are you a homeowner in Rockledge?
Field Data
Please Select
Yes
No
Are you registered to vote in Rockledge?
Field Data
Please Select
Yes
No
Are you a resident of Rockledge?
Field Data
Please Select
Yes
No
If so, how long?
Field Data
Not Applicable
0 - 1 Year
1 - 3 Years
3 - 5 Years
5 - 10 Years
10 - 20 Years
20 Years +
Are you currently serving on any other City Board(s) or Committee(s)? If so, please specify.
Please provide qualifications, experience and background that you fee would be beneficial to the board or committee selected.
Are you engaged in a business in Rockledge? If so, please describe business activity and indicate your title or position held.