Florida Governor Rick Scott

Submit Board Application

*Required fields

Step 1: Attach completed application form (Download application form)

Note: Files must be 2 MB or less in size (Please contact the Appointments office if you have a larger file to upload)
Application form*:    
I have attached my application form and am ready to continue

Step 2: Complete demographic and personal information**

Salutation*:  First Name*:  Middle Name: Last Name*:  Email Address*: 
Cell Phone Number (999) 999-9999*:  Fax Number (999) 999-9999: Race*:  Gender*: 
Specify the preferred mailing address*:

Residential Address

Address line 1*:  Address line 2: City*:  State*: 
County*:  Zip*:  Home Phone Number (999) 999-9999:

Business Address

Address line 1: Address line 2: City: State:
County: Zip: Business Phone Number (999) 999-9999:

Personal Information

The Executive Office of the Governor (EOG), as authorized by section 119.071(5)(a)(2), Florida Statutes, requests that you voluntarily submit your social security number (SSN). The EOG will use your SSN for purposes of conducting a background investigation relating to this application and may share the information with other agencies for the same purpose. If you provide your SSN, it will remain confidential and exempt and will not be disclosed to anyone outside of the EOG, except for the purposes mentioned in this disclosure or as otherwise provided by law. Your failure to provide your SSN may result in a delay in processing your application.
Date of Birth (mm/dd/yyyy)*:  Place of Birth*:  Social Security Number (999-99-9999)*: 
Driver's License Number: Issuing State:
Have you ever used or been known by any other legal name? If "Yes" list*:  If you are a naturalized citizen, date of naturalization: Since what year have you been a continuous resident of Florida?: Are you a United States Citizen? If "No" list countries: 
Are you a registered Florida voter? If "Yes" list*: County of registration:   Current party affiliation:  

Public Records

As a general matter, applications for appointment are public records, which may be requested by anyone; however, Florida law does provide some exemptions from the public records law for identifying information of certain covered individuals including their spouses and children.*** If you believe that an exemption from the public records law applies to your submission, please check the box below. By checking the box you are submitting a written request for the EOG to maintain the exemption of your identifying information as provided by law (see section 119.071(4)3., Florida Statutes).

Yes, I assert that my identifying information provided in this application is exempt from Florida’s public records law. 

Step 3: Select board seats to apply for

Functional Category (use to filter the boards below):
 
Board Name:*:
 
Select seats to add:*:

 

 

Your Selected Seats (select item and click "Remove" to remove from list)

If you submit without selecting at least 1 seat your data will not be saved

Step 4: Attach additional documents (optional)

Note: Files must be 2 MB or less in size (Please contact the Appointments office if you have a larger file to upload)
Additional file 1:  

Additional file 2:  

Additional file 3:  

Step 5: Submit board application



*Please don't close your browser during upload*
Notes
**This information will be used to provide demographic statistics and is not requested for the purpose of discriminating on any basis.

***Covered individuals include but are not limited to: current or former law enforcement officers, correctional and correctional probation officers, firefighters, service members serving after September 11, 2001, judges, assistant state attorneys, assistant and statewide prosecutors, assistant public defenders, personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement, and certain investigators in the Department of Children and Families (see section 119.071, Florida Statutes).

If you need additional guidance as to the applicability of any public records law exemption to your situation, please contact the Office of the Attorney General:

The Office of the Attorney General
PL-01, The Capitol
Tallahassee, Florida 32399
(850) 245-0158