Skip to Main Content
Loading
Loading
Departments
Government
Residents
Visitors
Doing Business
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Building
Building Records Request
Code Compliance
Community Relations
Engineering
Facility Rentals
Finance
Information Systems
Jupiter Jubilee
Jupiter U
Lobbyist
Natural Resources
Neighborhood Services
New Residents
Photo Contest
Planning and Zoning
Police
Public Works
PURE
Recreation
Special Events
Surveys
Town Clerk
Town Council
Town Manager
Utilities
Vendor Form
Waterway Trail
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.
Application to Serve on a Jupiter Board or Committee
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Personal Information
This section is complete
This section is incomplete
2.
Experience and Qualifications
This section is complete
This section is incomplete
Personal Information
Title
*
Mr.
Ms.
First Name
*
Last Name
*
Address Line 1
*
Address Line 2
City
*
State
*
Zip Code
*
Primary Phone
*
Home Phone
Email Address
*
Town of Jupiter Resident?
*
Yes
No
Qualification Information
"Summary of Boards and Committee Information"
Board or Committee
*
On which Board or Committee would you like to serve? (choose one).
Art Committee
Audit Committee
Construction Board of Adjustments & Appeals
Planning and Zoning Commission
Beach Committee
Historic Resources Board
Police Pension Board
Environmental Task Force
Alternate Board or Committee
Please choose an alternate if necessary. (optional)
Art Committee
Audit Committee
Construction Board of Adjustments & Appeals
Planning and Zoning Commission
Beach Committee
Historic Resources Board
Police Pension Board
Environmental Task Force
If you chose Planning and Zoning Commission as a primary or alternate , please enter your Voter Registration Number
Registration Number Found on Voter Card
Please Note:
All Town of Jupiter Board and Committee members are required to view the Palm Beach County Code of Ethics one hour long video prior to serving.
Continue
Experience and Qualifications
Work Experience
*
Please provide your last 5 years of work experience.
Occupation
Education
Qualifications
*
Decribe why your service on the requested board(s) or committee(s) would be beneficial to the Town of Jupiter.
Current or past Jupiter committee memberships
*
Name of any Town of Jupiter boards or commitee you currently serve on or have served on in the past (list dates; type "none" if you have never served).
Have you ever been convicted of a crime?
*
Yes
No
If yes, what was the crime and disposition of the case?
Are you aware of any potential conflict of interest that may arise from you serving on a Town Board or Committee per the Florida Code of Ethics or PBC Code of Ethics?
*
Yes
No
If yes, please explain.
Fla. Statute 760.80 requires the Town of Jupiter to maintain and report the following information:
Race/Ethnicity
*
African-American
Asian-American
Hispanic-American
Native-American
Caucasian
Gender
*
Male
Female
Physically Disabled
*
Yes
No
I understand the duties and responsibilities of the board(s) or committee(s) for which I am applying. By signing below, I warrant the truthfulness and accuracy of the information provided in this application, including that applicable to any personal information exemptions.
Signature of Applicant
*
Please type your First and Last name
Date
*
Acknowledgement
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Leave This Blank:
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
Home
Agendas & Minutes
Employment
Public Notices
Code Compliance Notices
Bids, RFP's & RFQ's
Public Records
Roads and Construction Projects
Help & Assistance Services
Election Information
Town Code
Hurricane & Flood Info
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow
