Committee Member Application Form

The Town of Miami Lakes is a public entity subject to Chapter 119 of the Florida Statutes concerning public records. Please be advised that all submitted Committee Member applications are a public record and therefore subject to the disclosure provisions of Chapter 119 of the Florida Statutes.

Applicant's Information

Name(Required)

First Middle Initial Last

Occupation

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile Phone

Other Phone

Email(Required)

Length of Residence in Miami Lakes (if applicable)

Please enter a number greater than or equal to 0.

Years

Number

Please enter a number greater than or equal to 0.

Months

Length of Time of Business Miami Lakes (if applicable)

Please enter a number greater than or equal to 0.

Years

Number

Please enter a number greater than or equal to 0.

Months

On the questionnaire below, please select any category which may apply to you. Identity of the applicant is confidential and compliance is strictly voluntary. Information will be used solely to comply with the reporting requirements of Section 760.80, Florida Statutes.

Race

African-American

Asian-American

Caucasian

Hispanic-American

Pacific Islander

Not Known

Gender

Male

Female

Other

Are you physically disabled?

Yes

Please select the committee(s) you are interested in joining

*Please note that some committees and its members are subject to criminal background checks. Per AO #07-01

Committees

COMMITTEE MEMBER JOB DESCRIPTION

Orientation documents and training videos are provided to make sure members are comfortable and knowledgeable in their role.

Expectations

Commit time for regular meetings
Attend events
Volunteer at special events, as required
Engage in critical though and be committed to a vibrant future
Prepare well for meetings, reviewing and commenting on minutes and reports
Listen well and be thoughtful in considering issues
Understand the fiscal implications of decisions
Be knowledgeable about the committees mission, and programs
Be an ambassador for the committee and promote its work in the community

To carry out these responsibilities, the committees meet once a month unless superseded by resolution.

Why are you interested in joining this Committee?

Please describe the area(s) of expertise/contribution you feel you can make to the Town and the committee you are interested in joining.

Please tell us about yourself (education, profession, personal accomplishments, honors received, hobbies).

Do you have previous experience on a Committee of Board?

Yes

If yes, please specify.

Resolution No. 25-2123 requires all applicants to attend one (1) meeting before being appointed to a committee. Enter date of meeting in which you attended.

Date of Meeting Attended
MM slash DD slash YYYY

Signature

Date
MM slash DD slash YYYY

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