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Board or Commission Member Candidate Application Form

  1. * Requred Fields
  2. PERSONAL INFORMATION
  3. Title*
  4. (*this information is requested persuant to Section 760.80 Florida Statutes)
  5. Are you a registered voter in the City?*
  6. Zone*
  7. Is your primary residence in Daytona Beach?*
  8. Are you a U.S. citizen?*
  9. Do you require special accomodations?*
  10. BUSINESS INFORMATION
  11. Do you own property in Daytona Beach?*
  12. Do you own a business in Daytona Beach?*
  13. Are you employed in Daytona Beach?*
  14. EDUCATION / EXPERIENCE
  15. Select areas of special knowledge or expertise applicable to the board opening you are applying for (see listing below)*
  16. Have you attended one or more meetings of the board for which you are applying?*
  17. Do you currently serve or have you ever served on a board?*
  18. Select the board or commission membership of interest*
  19. I understand the responsibilities associated with being a board member, and I have adequate time to serve if appointed.*
  20. I understand The City of Daytona Beach may conduct a background check including a criminal history and code violations check and that the information so obtained will be maintained on file with my application*
  21. Leave This Blank:

  22. This field is not part of the form submission.