Board Seat Application Florida Executive Office of the Governor Web Portal

Submit Board Application

Step 1: Download and complete the Appointment Questionnaire

Please note: This file must be downloaded to your local computer before being filled out. There is no save feature included with the online version of this form. Any information entered to the online version of the forms will be lost when downloaded. After the .pdf is downloaded and filled out it can be saved to your computer for upload and to retain a copy for your records.

Step 2: Attach completed Appointment Questionnaire

Note: Files must be 5 MB or less in size (Please contact the Appointments office if you have a larger file to upload)

Application Questionnaire*: Attach an Application Questionnaire! File type not allowed. Allowed types are .doc, .docx, .pdf, .xls, .xlsx, .txt

I have attached my Appointment Questionnaire and am ready to continue.

Step 3: Complete demographic and personal information**

Salutation*: Salutation is required. First Name*: First name is required. Middle Name: Last Name*: Last name is required. Email Address*: Email address is required.

Cell Phone Number (999) 999-9999*: Cell phone is required. Fax Number (999) 999-9999: Race*: Race is required. Gender*: Gender is required.

Specify the preferred mailing address*:

Business

Residential

Residential Address

Address line 1*: Resident Address 1 is required. Address line 2: City*: Resident city is required. State*: Resident state is required.

County*: Resident county is required. Zip*: Resident zip code is required. 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)*: Birth date is required. Place of Birth*: Birth place is required. Social Security Number (999-99-9999)*: SSN is required.

Driver's License Number: Issuing State:

Have you ever used or been known by any other legal name? If "Yes" list*: Name change text is required

Yes

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: Please list

Yes

Are you a registered Florida voter? If "Yes" list*:

Yes

County of registration: Voter county is required. Current party affiliation: Voter party is required.

Step 4: Select board seat(s) to apply for

Functional Category (use to filter the boards below):

Board Name:*

Select seat(s) to add:*

Your selected seat(s): (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 5: Attach additional documents (optional)

Note: Files must be 5 MB or less in size (Please contact the Appointments office if you have a larger file to upload)

Additional file 1: File type not allowed. Allowed types are .doc, .docx, .pdf, .xls, .xlsx, .txt

Additional file 2: File type not allowed. Allowed types are .doc, .docx, .pdf, .xls, .xlsx, .txt

Additional file 3: File type not allowed. Allowed types are .doc, .docx, .pdf, .xls, .xlsx, .txt

Step 6. Public Records Exemption

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 download and complete the public records exemption request form, upload the form, and check the boxes 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).

File type not allowed. Allowed type is .pdf
Yes, I assert that my identifying information provided in this application is exempt from Florida’s public records law.
I have attached my Public Records Exemption Request form and I am ready to continue .

Step 7: Submit complete Board Application

*Please don't close your browser during upload*

Notes
*Mandatory Field

**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