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Board or Commission Member Candidate Application Form

  1. * Requred Fields


  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?*


  11. Do you own property in Daytona Beach?*

  12. Do you own a business in Daytona Beach?*

  13. Are you employed in Daytona Beach?*


  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.