Language
English (US)
Español
Board Member Application
Your Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
(required for confirmation)
Phone Number
*
Format: (000) 000-0000.
Are you a voter in the City of Kissimmee?
*
Yes
No
Is your permanent residence serviced with electricity by KUA?
*
Yes
No
Do you hold an elected, governmental position?
*
Yes
No
Are you employed by City of Kissimmee?
*
Yes
No
Are you aware that Authority Members are non-paid?
*
Yes
No
Are you currently willing and do you have the time necessary to serve as an Authority Member?
*
Yes
No
Are you a sworn law enforcement officer?
*
Yes
No
How long have you lived in the Kissimmee Utility service area? Please list how many years and months.
Please list any formal education you’ve had, including the institution name and location, dates attended, degree received, and date received.
*
Please upload a copy of your resume.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please list any additional supporting documents you’d like to provide.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please list any management experience you’ve had including the name & location, the dates from-to, your title, degree of responsibility, number of employees for which you were responsible and budgetary dollars for which you were responsible.
*
Please list any civic activities: (Service Club, Church Activities, City Boards, etc.)
*
Date
*
-
Month
-
Day
Year
Date Picker Icon
Certification
*
I hereby certify that I meet the requirements of board member in the KUA Charter and I further certify that I am a customer in good standing with KUA, with all KUA services in my name or for which I am responsible in a current, non-delinquent status.
Acknowledge
*
By submitting this form, I acknowledge I have reviewed all the necessary documents listed on this page.
Please verify that you are human
*
Submit
Should be Empty: