Skip to Main Content

Cocoa Beach, FL

Create a Website Account - Manage notification subscriptions, save form progress and more.

Website Sign In

How Do I...
Government
Services
Residents
Business
Visitors

Go to Site Search

Search

Home
Form Center

Form Center

Search Forms by:

Enter Search Terms Select a Category

Select category/categories to filter

All Categories
City Clerk
Committees
Finance

Fire
Information Technology
Leisure Services

Police
Public Notice
Water Reclamation and Stormwater

Search

By signing in or creating an account, some fields will auto-populate with your information.

Application for Appointment to Boards and Committees

Sign in to Save Progress

This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Step One (current) This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete
3. Step Three This section is complete This section is incomplete

Step One

Please check all the Boards/Committees you are interested in serving*
1. Board of Adjustment
2. Sustainable Land Advisory Committee
3. Leisure Services Board
4. Planning Board
5. General Employees Pension Board
6. Fire Pension Board
7. Police Pension Board
8. Other
Other - please specify
Are you able to attend?
Majority of meetings are held after 4:00 pm Monday - Friday.
Determination of the meeting day and time will be determined by the board/committee.
1. Evening Meetings
2. Morning Meetings
3. Both, Evening and Morning
First Name*
Last Name*
Address1*
Address2
City*
State*
Zip
Phone Number *
Fax Number
E-Mail Address*
EMPLOYMENT
Employer
Occupation
Address1
Address2
City
State
Zip
E-Mail
Job Responsibilities
Resume Upload
EDUCATION
Type of School
1. High School
2. College or Trade School
3. Other
Name of Last School and Location
Major or Degree
No. Years Completed
Continue

Step Two

Are you related to a current Cocoa Beach Commissioner or City Employee?
1. Yes
2. No
If yes, you are related to a current Cocoa Beach Commissioner or City Employee, please explain
Have you ever held a business tax receipt
1. Yes
2. No
If yes, please provide the following
Title
Issue Date
Issuing Authority
Do you own property in the City of Cocoa Beach?
1. Yes
2. No
Are you a resident of the City?
1. Yes
2. No
If yes, how long? (Years/Months)
How long have you been a resident of Brevard County? (Years/Months)
Are you a United States citizen?
1. Yes
2. No
Are you a registered voter of the City?
1. Yes
2. No
Are you employed by the City
1. Yes
2. No
If yes, what department?
Do you presently serve on a City Board/Committee?
1. Yes
2. No
If yes, please list Board(s)/Committee(s)
Have you previously served on a City Board/Committee?
1. Yes
2. No
If Yes, please list Board(s)/Committee(s)
Are you currently serving on a Board, Authority, Commission for another government agency?
1. Yes
2. No
If yes, please specify
Have you ever been convicted or pled guilty to a criminal charge or pled nolo contendere (no contest) to a criminal charge?
1. Yes
2. No
If yes, what charge?
Where?
When?
Disposition?
Have your rights been restored?
1. Yes
2. No
Are you a member or participant of any community organization?
1. Yes
2. No
If yes, please list
What are your hobbies/interests?
Please explain why you wish to serve on the City's Board/Committee?
Continue |Go Back

Step Three

Florida Statutes Section 760.80 requires certain information on Created Boards/Committees
Race
1. African-American
2. Asian-American
3. Hispanic-American
4. Native-American
5. Caucasian
6. Not Known
Gender
1. Male
2. Female
Disability
1. Physically Disabled
2. Not Physically Disabled
APPLICANT CERTIFICATION
By filing this application with the City of Cocoa Beach, I do hereby acknowledge the following: 1) This application when completed is a public record and open to public inspection. 2) I am responsible for keeping information current with the City. 3) I consent to the filing of the State Form, Statement of Financial Interest (Form 1), if required by the Board. (http:/www.ethics.state.fl.us/ethics/forms.html). 4) If appointed, it is my obligation to comply with the State of Florida Code of Ethics. 5) I acknowledge that I will have adequate time to serve on the Board/Committee. The information provided on this form is true and correct.
I understand that the City will acknowledge receipt of my Board/Committee application and that my application will remain active for 6 months from the date of submission.
If I am selected to serve on a Board/Committee, the City will notify me, otherwise if not selected, I will receive no notice. At any time, I may withdraw my application by contacting: cityclerk@cityofcocoabeach.com.
Submitted by (Print Your Name): *
Date*
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

* indicates a required field

E-MAIL DISCLAIMER Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. ▲ Back to top

Parking Permits
Learn More

Public Safety
Learn More

Agendas & Minutes
Learn More

Report a Concern
Learn More

Building Permits
Learn More

Notifications
Learn More

2 S. Orlando Ave

P.O. Box 322430

Cocoa Beach, FL 32932-2430

Business Hours: 8:30am-4:30pm

Phone: 321-868-3200

Home

Site Map

Contact Us

Accessibility

Copyright Notices

Privacy Policy

/QuickLinks.aspx

Under Florida Law, email addresses are public records
If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. (SB 80 Florida State Law)

Government Websites by CivicPlus®

Loading

Loading

[]