Forms • Board or Commission Member Candidate Application For

Select the board or commission membership of interest.

Pursuant to Florida Statutes, Chapter 119, this application and any other related written or electronic communication shall become a public record subject to public disclosure.

Completed applications will be kept active for one (1) year from the date received in the Office of the City Clerk. All persons seeking re-appointment must also submit an application to be considered.

Per Resolution No. 2022-01(as amended by Resolution No. 2025-289), all members of City boards appointed by the City Commission shall attend 4 hours of training upon appointment and reappointment that includes the topics of training required of elected municipal officers by Section 112.3142, Florida Statutes.
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PERSONAL INFORMATION

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Title*

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Home Phone*

Cell Phone*

Race - (*this information is requested pursuant to Section 760.80 Florida Statutes)*

Sex*

Date of Birth*

Email Address*

Are you a registered voter in the City?*

Zone*

Is your primary residence in Daytona Beach?*

FOR OFFICE USE ONLY

ZONE

PRECINCT

DATE VERIFIED

Are you a U.S. citizen?*

Do you require special accommodations?*

Yes

No

If you require special accommodation, please list.

Business Information

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Do you own property in Daytona Beach?*

Yes

No

Do you own a business in Daytona Beach?*

Yes

No

Business Address

Business Phone

Are you employed in Daytona Beach?*

Yes

No

Employer Name and Address*

Occupation*

EDUCATION/EXPERIENCE

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List all Professional Degrees, Licenses and Certificates*

Select all areas of special knowledge or expertise applicable to the board opening you are applying for (see listing below)*

How does your special knowledge/expertise pertain to the board opening you are applying for?

Additional Information (Civic Activities, memberships, etc.

Why are you interested in serving on a City Board or Commission?

Have you attended one or more meetings of the board for which you are applying?*

Yes

No

Do you currently serve, or have you ever served on a board?*

Yes

No

If So, which board?

How many years have you served?

If this is a reappointment, how long have you served on this board?

Other Board

I understand the responsibilities associated with being a board member, that some boards require electronic filing of an Annual Financial Disclosure (boards indicated above), and I have adequate time to serve if appointed.*

Yes

No

*I understand that membership in the Affordable Housing Advisory Committee requires qualification in one of the eleven (11) categories listed below.*

Yes

No

***If you are applying for the Affordable Housing Advisory Committee (AHAC) you must complete this section. If you are NOT applying for AHAC, select N/A below.***

Governed by Ordinance No. 93-37, Ordinance No. 96-259, Ordinance No. 08-112, Ordinance 19-39, and F.S. 420.9072(9), amended by F.S. 420.9076 (2), states that the Advisory Committee shall consist of at least 8 but not more than 11 committee members who are citizens recommended by the City Manager, the Mayor, or any City Commissioner and appointed by resolution of the City Commission for a two (2) year term. Effective October 1, 2020 the committee must consist of one locally elected official from each county or municipality participating in the State Housing Initiatives Partnership Program (CC) and the committee must consist of one representative from at least six of the following categories, actively engaged and specifically in connection with affordable housing. Pursuant to s. 163.3174, if the local planning agency is comprised of the governing board of the county or municipality, the governing board may appoint a designee who is knowledgeable in the local planning process to satisfy the necessary category. *

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. *

Yes

No

* indicates required fields.

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