City of Deltona FL
2345 Providence Blvd., Deltona, FL 32725
Citizen Board/Committee Application
Choose from the following:
Affordable Housing Advisory Committee
Parks & Recreation Youth Advisory Sub-Committee
Economic Development Advisory Board
Firefighter's Pension Plan Board of Trustees
Parks & Recreation Advisory Committee
Planning & Zoning Board
Parks & Recreation Senior Advisory Sub-Committee
William S. Harvey Scholarship Selection Committee
Parks & Recreation Citizen Accessibility Advisory Sub-Committee
Ordinance Review Committee
Other Boards/Committees (Write Board Name in "Additional Information")
Please provide the following information:
Number of Years as a Deltona Resident
0 - 1 Year
2 - 5 Years
6 - 10 Years
11 - 15 Years
16 - 20 Years
21 - 25 Years
What Commission district do you reside in?
Are you a registered voter in Volusia County?
Not Applicable/Youth Boards
Who is your employer? (Please include number of years, address, phone number and title/position)
Please summarize your work experience.
List any volunteer service organizations, clubs, or professional societies you are a member of and give the positions or titles you have held.
Have you ever served on a committee or advisory board? If so, give the details, including any positions held. Have you ever held public office? If so, give the details, including offices involved, whether elected or appointed, and the length of service.
Describe any additional knowledge, skill, education, or experience you have, which would assist you in the duties of this Board/Committee.
Explain why you want to serve on this Board/Committee, and include any potential contribution you selection would bring.
Potential conflict of interest: Do you do business, or are you engaged in the management of any business enterprise that has a financial interest with the City of Deltona? Please give details, including the name of the enterprise, the nature of the business, and the position you hold.
Have you ever been convicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? If so, give details. Do not include traffic violations or fines of $100 or less that were imposed, unless it also included a jail sentence.
List names, addresses, and telephone numbers of at least three persons who are in a position to comment on your qualifications and of whom inquiry may be made by the City of Deltona.
Additional Information or Comments