Pinellas: Board Application

Profile

Begin by inserting your email address. If you have an existing account, a message will be delivered to the email address on file. Please use a single email address throughout your experience with the Pinellas Boards, Councils, and Committees application. For specific instructions, visit www.pinellascounty.org/boards/applicants.htm.

Prefix

First Name *
Middle Initial
Last Name *

Email Address *

Street Address *
Suite or Apt
City *
State *
Postal Code *

Primary Phone Primary Phone
Alternate Phone Alternate Phone

Employer
Job Title

Occupation *

Which Boards would you like to apply for? *

This board has a vacancy

Are you currently a Pinellas County resident? * Yes No

If you are a Pinellas County resident, for how long?

Are you registered to vote in Pinellas County? * Yes No

Are you currently serving on any Pinellas County boards, councils, or committees? * Yes No

If you are currently serving on any Pinellas County boards, councils, or committees, please name.

Do you have or hold any employment or contractual relationship with any business or any agency which is subject to the regulation of or is doing business with Pinellas County? * Yes No

If you have or hold any employment or contractual relationship with any business or any agency which is subject to the regulation of or is doing business with Pinellas County, please explain.

Do you serve on any state, regional or local government boards, councils or committees? * Yes No

If you serve on any state, regional or local government boards, councils or committees, please explain.

Are you current with all taxes and any other financial obligations? * Yes No

If you are not current with all taxes and any other financial obligations, please explain.

Have you been convicted of a Public Entity Crime? Public entity crime is defined by Florida Statute, sec. 287.133 as a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid, proposal, reply, or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. * Yes No

If you have been convicted of a Public Entity Crime, please explain.

Have you been convicted of a financial felony? * Yes No

If you have been convicted of a financial felony, please explain.

Have you ever been convicted of a crime against children or seniors? * Yes No

If you have ever been convicted of a crime against children or seniors, please explain.

Are you currently, or have you ever sued Pinellas County? * Yes No

If you currently, or have ever sued Pinellas County, please explain.

Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid) * Yes No

If you have ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation or ordinance, please explain.

Interests & Experiences

State your background, including your education, work experience, civic or community organization memberships and positions, and any professional licenses or memberships, and explain how this applies to the function of the board, council or committee.

Upload a Resume
Please upload your resume

Demographics

Ethnicity
Gender
Date of Birth

The Pinellas County Commission strives to promote diversity and provide reasonable accommodations for individuals with disabilities. If you are requesting accommodation, please indicate below:

I understand the responsibilities and commitment of time associated with an appointment to a Pinellas County board, council or committee. *

I Agree *

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Boards, Councils, and Commissions

Profile

THESE BOARD-SPECIFIC QUESTIONS HAVE BEEN ADDED TO YOUR APPLICATION:

Interests & Experiences

Demographics

I understand the responsibilities and commitment of time associated with an appointment to a Pinellas County board, council or committee. *

Please fill out all required fields and correct any errors before submitting.