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Citizen Application Form

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For Boards and Committees

Please correct the field(s) marked in red below:

1.  Fill out the form below and click submit.  The form will be sent to the person responsible for compiling applications.

2.  You can download the Word-icon word application below, complete, and send as an attachment via email at Jaclyn.Slaybaugh@claycountygov.com.  The form can also be filled, printed and mailed to:

Clay County BCC
Attention: Jaclyn Slaybaugh
PO Box 1366
Green Cove Springs, Florida 32043

3.  You can open the Adobe-PDF-Document-icon16 Adobe .pdf document below, complete and click submit (for Adobe Standard and Pro users only) or download the file to your files, complete in Adobe Reader and submit as an attachment via email to Jaclyn.Slaybaugh@claycountygov.com or mail the form to the address above.

Word-icon Application in Word format

Adobe-PDF-Document-icon16 Application in PDF format

1
Your Information:
 *
Your Information:
2
Education
 *
3
Volunteer Work, Civic, Professional, and other Activities
 *
Volunteer Work, Civic, Professional, and other Activities
4
Reason for Serving
Reason for Serving
5
Miscellaneous
 *
Miscellaneous
6
References
 *
References

By submitting this form, I declare the foregoing facts to be true, correct and complete.

This form can be submitted via email or can be printed and brought into our office. For any questions concerning this form please contact our County Manager's Office at (904) 284-6352.

You may submit only one application for each committee vacancy. A new application must be submitted for each committee vacancy. Applications will not be kept after a vacancy has been filled.

  1. To receive a copy of your submission, please fill out your email address below and submit.
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