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CareerSource Palm Beach County, Inc. Application

  1. The information provided on this form will be used in considering your appointment. Please COMPLETE SECTION II IN FULL. Answer “none” or “not applicable” where appropriate. Please attach a biography or résumé to this form.
  2. Section I: Board Name: CAREERSOURCE PALM BEACH COUNTY, INC.
  3. X Not Advisory
  4. X New Appointment
  5. Section II: (Applicant):
  6. APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
  7. Type of Employment*
  8. Mailing Address Preference:*
  9. Have you ever been convicted of a felony:*
  10. Gender:
  11. Minority Indentification Code:
  12. CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member’s board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
  13. Example: (R#XX-XX/PO XX)
  14. Example: Parks & Recreation
  15. Example: General Maintenance
  16. 10/01/00-09/30/2100
  17. Or Select:
      1. If appointed, all board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment. Article XIII, and the training requirement can be found on the web at: http://www.palmbeachcountyethics.com/training.htm Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
      2. Leave This Blank:

      3. This field is not part of the form submission.