Skip to Main Content
Loading
Loading
Traffic Alert
Road Closure - Diplomat Parkway
Read On...
HBHereForYou
Departments
Services
Business
Projects
Visit Hallandale Beach
How Do I...
Home Page
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
City Clerk
Communications Dept
CRA COVID-19 Loan Program
Development Services
Finance
Fire Department
Human Services
I.T.
Police Department
Public Works
Transportation and Mobility
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.
Committee Member Application Form
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Committee Member Application Form
The City of Hallandale Beach is a public entity subject to Chapter 119 of the Florida Statutes concerning public records. Please be advised that all submitted Board and Committee applications are a public record and therefore subject to the disclosure provisions of Chapter 119 of the Florida Statutes.
APPLICANT'S INFORMATION
LAST NAME:
*
FIRST NAME
*
CONTACT NUMBER:
*
EMAIL:
*
Address1
Address2
City
State
Zip
OCCUPATION:
If applicable, how long have you lived in Hallandale Beach?
VERIFICATION OF RESIDENCY:
Driver’s License (Required)
Voter’s Registration Card (Required)
Verification of good standing with the City of Hallandale Beach: (No outstanding Liens, Taxes, Open Permits, Utility Balances, Code Cases, Pending Litigation )
On the questionnaire below, please select any category which may apply to you. Identity of the applicant is confidential and compliance is strictly voluntary. Information will be used solely to comply with the reporting requirements of Section 760.80, Florida Statutes.
PHYSICAL DISABILITY
Yes
No
GENDER
Female
Male
RACE
African-American
Hispanic-American
Asian-American
Native American
Caucasian
Other
Please choose your first, second, and third choices among the following Boards and Committees. If you are interested in only one, this should be indicated.
(At any given time, board members may not serve on more than one board and one committee or on two boards or on two committees)
Committees
Accessibility Advisory Board
Beach Preservation Advisory Board
Beautification Advisory Board
Charter Review Committee
Civil Service Board
Education Advisory Board
Golden Isles Safe Neighborhood Advisory Board
Historic Preservation Board
Parks & Recreation Advisory Board
Planning & Zoning Board
Police/Fire Pension Board
Public Transportation, Traffic and Parking Advisory Board
Sustainability and Flood Mitigation Advisory Board
Three Islands Safe Neighborhood Advisory Board
Unsafe Structures Board
*Required Member Qualification. **Required Statement of Financial Interest (Form 1). The following Board/Committee members are required to disclose their Financial Interest (Form 1) annually: All Board/Committee members are subject to Sunshine Law training.
Please tell us about yourself (education, profession, personal accomplishments, honors received, hobbies), list your experience relevant to the committee(s) you are applying for, and provide a brief statement outlining why you wish to serve on the committee(s) you have selected above.
PLEASE TELL US ABOUT YOURSELF
Signature of Applicant:
Date:
Last Name:
First Name:
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
Submit and Print
* indicates a required field
E-mail Notifications / Notify Me
Hallandale Beach Happenings
News Flash
Parks Master Plan
Online Payments
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow