Boards, Councils, and Committees Application - Economic Development Council

This application applies to citizens who wish to volunteer to be appointed to boards, councils or committees under the purview of the Board of County Commissioners by individual county commissioners or the County Commission as a whole. Please read the Important Information section at the end of this application. If you agree to the terms, you may fill out the form electronically,and submit.

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* 1. First Name

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* 2. Last Name

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* 3. Home Address

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* 4. City

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* 5. State

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* 6. ZIP Code

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* 7. Home Phone

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* 8. Home Fax

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* 9. Home Email

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* 10. Mailing Address

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* 11. City

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* 12. State

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* 13. ZIP Code

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* 14. Are you currently a Pinellas County resident?

Yes

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* 15. If yes, for how long?

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* 16. Are you registered to vote in Pinellas County?

Yes

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* 17. Occupation

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* 18. Title

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* 19. Name of Business

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* 20. Business Address

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* 21. City

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* 22. State

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* 23. ZIP Code

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* 24. Business Phone

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* 25. Business Fax

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* 26. Business Email

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* 27. State your background, including your education, work experience, civic or community organization memberships and positions, and any professional licenses or memberships, and explain how this applies to the function of the board, council or committee:

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* 28. Are you currently serving on any Pinellas County boards, councils, or committees?

Yes

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* 29. If yes, please name

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* 30. Do you have or hold any employment or contractual relationship with any business or any agency which is subject to the regulation of or is doing business with Pinellas County?

Yes

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* 31. If yes, please explain

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* 32. Do you serve on any state, regional or local government boards, councils or committees?

Yes

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* 33. If yes, please explain

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* 34. Are you current with all taxes and any other financial obligations?

Yes

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* 35. If no, please explain

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* 36. Have you been convicted of a Public Entity Crime?

Yes

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* 37. If yes, please explain

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* 38. Have you been convicted of a financial felony?

Yes

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* 39. If yes, please explain

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* 40. Have you ever been convicted of a crime against children or seniors?

Yes

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* 41. If yes, please explain

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* 42. Are you currently, or have you ever sued Pinellas County?

Yes

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* 43. If yes, please explain

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* 44. Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid)

Yes

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* 45. If yes, please explain

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* 46. The Pinellas County Commission strives to promote diversity and provide reasonable accommodations for individuals with disabilities. If you are requesting accommodation, please indicate below:

Important Information Be advised that:
1. Membership on certain boards, councils or committees may have specific membership requirements, require an invoice of financial disclosure and/or require the submission of other information.
2. This application form, when completed and filed with Pinellas County, is a public record under Chapter 119, Florida Statutes and is open to public inspection.
3. Resumes may be sent to committees@pinellascounty.org, but the application must be completed in order to be considered. You may use additional pages if necessary. The applicant is responsible for keeping information on the applicant current.
4. All material submitted to Pinellas County government is subject to the public records law of the State of Florida.

I understand the responsibilities and commitment of time associated with an appointment to a Pinellas County board, council or committee. By clicking and submitting you have electronically signed this application and confirmed that the information provided is true and factual.

Thank you for your interest in serving on a board, council or committee for Pinellas County government. All board, council and committee meetings are open to the public. You are encouraged to attend a meeting to learn more about the duties of a member or the work of the board, council or committee in which you are interested.

If you have any questions regarding the completion and submission of this application or the duties and scope of responsibilities of the specific board, council or committee in which you are interested, contact the staff representative mentioned in the advertisement or listed in the committee listing.