Skip to Main Content

Create an Account - Increase your productivity, customize your experience, and engage in information you care about.

Sign In

Search

Home
My Account
Printer Friendly
Email Page
Contact Us
RSS
Site Map
Translate Page
Notifications
Documents

Government
Services
Residents
Business
How Do I...

You Are Here:
Home
Form Center

Form Center Module

Form Center

Search Forms:

Search Forms Select a Category

All Categories
Boards and Committees
Business Development Committee
Code Enforcement

Fire Department
Flood Plain Management
Holiday Decoration Contest Nomination Forms

Planning / Zoning
Police
Redevelopment Agency

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Sign in to Save Progress

Application for Board / Committee Membership

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

Steps

1. Contact Information This section is complete This section is incomplete
2. Board / Committee Selection This section is complete This section is incomplete
3. Miscellaneous Information This section is complete This section is incomplete

Contact Information

First Name*
Last Name*
Street Address*
Mailing Address, if different
City*
State*
Zip*
Home Phone*
Cell Phone*
Work Phone
Email address*
Employer or Business*
If retired, please indicate career field or name of business at retirement
Title/Position Held*
Continue

Board / Committee Selection

Available Boards and Committees*
You may make more than one selection
1. Board of Adjustment
2. Board of Adjustment & Appeals
3. Business Development Committee
4. Citizens Advisory Committee to the Space Coast Transportation Planning Organization
5. Citizen Representative to Economic Development Commission of Florida's Space Coast
6. Community Redevelopment Agency Board of Commissioners
1. Code Enforcement Board
2. Planning Commission
3. Retirement Board, Fire Employees
4. Retirement Board, General Employees
5. Retirement Board, Police Employees
6. The Rockledge Environmental Enhancement (T.R.E.E.) Board
Continue |Go Back

Miscellaneous Information

Miscellaneous Information
Please answer "Yes" or "No" where indicated
Are you currently serving on any City Board(s) or Committee(s)?*
If yes, please specify
Have you ever served on a City of Rockledge board?*
1. Yes
2. No
If yes, please list board(s) and dates of service
Are you a resident of Rockledge?*
If yes, how long?
Are you a homeowner in Rockledge?*
Are you registered to vote in Rockledge?*
Are you engaged in a business in Rockledge?*
Please provide qualifications, experience and background that you feel would be beneficial to the board or committee selected
Note:
Applications will be kept on file for a period of two (2) years. Periodic contact will be made to inquire into your interest in appointment to the selected board or committee before your application is submitted to the City Council.

Leave This Blank:

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

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

* indicates a required field

Newsletters
Quick Links

Job Opportunities
View current opportunities.

Public Records Request
Submit your records request.

Community Redevelopment
Stay informed on city projects.

Agenda Center
Follow city board meetings.

Municipal Code
Learn about city code.

Quick Links

Comprehensive Plan
Land Development Regulations
Municipal Code
Florida Department of Economic Opportunity
St. Johns River Water Management District
Florida Department of Transportation

/QuickLinks.aspx

Helpful Links

Boards and Commissions
Code Enforcement
Garbage and Recycling
Local Activities
Recreation
The Neighborhood Watch Program

/QuickLinks.aspx

Home

Contact Us

Site Map

Accessibility

Copyright Notices

/QuickLinks.aspx

City of Rockledge

1600 Huntington Lane

Rockledge, FL 32955

Phone: 321-221-7540 or 321-604-3017

Fax: 321-204-6356

Government Websites by CivicPlus®

[]