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Personal Information
Please Note
Application for Appointment (PDF)
By Florida law, this document is a public record. If you do not want your email address released in response to a public records request, please download the Application for Appointment in PDF format and omit your email address. If your home address and phone number are exempt under Florida Statutes, please advise the Clerk's office when submitting this form.
Date*
Date
First Name*
Last Name*
Home Address*
Address2
City*
State
Zip*
Primary Phone Number*
Email Address*
Village of NPB Resident*
1. Yes
2. No
Residency
1. Year-Round Resident
2. Seasonal Resident
Length of residency in NPB
Number of months or years
Registered Voter*
1. Yes
2. No
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Board and Committee Information
Summary of Board and Committee requirements and duties
Board or Committee*
Please select the board or committee on which you wish to serve.
Alternate Board or Committee
Please choose an alternate, if interested in more than one board or committee.
Why are you interested in serving on this Board?*
Golf Advisory Board Applicants
Please check all that apply
1. Golf Member
2. MGA Member
3. WGA Member
4. Non-Member
Volunteer experience
Please list any current or prior volunteer experience on a board, committee, association, etc.
Do you currently serve on a Village Board?
1. Yes
2. No
Current Village Board
Financial Disclosure
Form 1
Members of the Pension Boards and Planning Commission are required to file Form 1, Statement of Financial Interests, within 30 days of appointment, and annually by July 1st following each calendar year in which they hold their position.
Ethics Training
PBC Commission on Ethics
All board members must view the Palm Beach County Commission on Ethics training video and read the Code of Ethics.
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Education and Professional Experience
Occupation*
Present occupation, or former (if retired)
Resume Attached?
(Optional)
1. Yes
2. No
Upload your resume here
Business Address
Business Phone Number
Business Email
Education and/or Experience*
Brief description of pertinent education and/or experience
Areas of Special Interest or Additional Information
Specific areas of interest or additional info you'd like to include
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