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Committee Member Application Form

  1. Committee Member Application Form

    The City of Hallandale Beach is a public entity subject to Chapter 119 of the Florida Statutes concerning public records. Please be advised that all submitted Board and Committee applications are a public record and therefore subject to the disclosure provisions of Chapter 119 of the Florida Statutes.

  2. APPLICANT'S INFORMATION

  3. VERIFICATION OF RESIDENCY:

  4. VERIFICATION OF GOOD STANDING WITH THE CITY OF HALLANDALE BEACH:

  5. 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.

  6. PHYSICAL DISABILITY

  7. GENDER

  8. RACE

  9. Please choose your first, second, and third choices among the following Boards and Committees. If you are interested in only one, this should be indicated.

  10. Committees

  11. Please tell us about yourself (education, profession, personal accomplishments, honors received, hobbies), list your experience relevant to the committee(s) you are applying for, and provide a brief statement outlining why you wish to serve on the committee(s) you have selected above.

  12. Leave This Blank:

  13. This field is not part of the form submission.