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2. This application will be utilized in considering you for appointment to a City Council board, authority, or commission. Pursuant to Florida Statutes, Chapter 119, all information provided on or with this form becomes a public record and is subject to disclosure, unless otherwise exempted by law.
   
   Completed applications will be kept on file for a period of one (1) year from the date received in the Office of the City Clerk.
   
   It is necessary to contact a member of Council to obtain a nomination in order to be placed on the ballot for consideration. Please go to cityofpensacola.com/council for Council Member contact information. If you have any questions, contact the City Clerk’s Office.
6. Personal Information
8. Name*
10. Home Address*
11. Business Address
12. To which address do you prefer we send correspondence regarding this application?

    1. Home

    1. Business
14. Preferred Contact Phone Number(s)*
15. Email Address*
17. Upload Resume (optional)
21. Details
23. Are you a City resident?*

    1. Yes
    2. No
24. If yes, which district?
    -- Select One --1234567
25. If yes, how long have you been a City resident?
27. Do you own property within the City limits?*

    1. Yes

    1. No
28. Are you a registered voter in the city?*

    1. Yes

    1. No
30. Board(s) of interest:*
31. Please list the reasons for your interest in this position:*
33. Do you currently serve on a board?*

    1. Yes

    1. No
34. If yes, which board(s)?
36. Do you currently hold a public office?*

    1. Yes

    1. No
37. If so, what office?
39. Would you be willing to resign your current office for the appointment you now seek?*

    1. Yes

    1. No

    1. N/A

    The Florida Constitution, in section 5 (a) of Article II, prohibits simultaneous “dual office holding”. If you were already serving on a board, authority, or commission for the City of Pensacola or for another governmental agency, would you be willing to resign in order to accept the appointment you now seek?
43. Diversity
    In order to encourage diversity in selections of members of government committees, the following information is required by Florida Statute 760.80 for some committees.
45. Gender
    -- Select One --MaleFemale
46. Race
    -- Select One --African-AmericanAsian-AmericanHispanic-AmericanCaucasianOther
47. Physically Disabled
    -- Select One --YesNo
51. Acknowledgement of Terms*

    I hereby certify that the statements and answers provided are true and accurate. I understand that any false statements may be cause for removal from a board or committee if appointed.

    1. I accept these terms.
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field