Questionnaire for Gubernatorial Appointments

The information from this questionnaire will be used by the Governor’s office and, where applicable, The Florida Senate in considering action on your confirmation. The questionnaire MUST BE COMPLETED IN FULL. Answer “none” or “not applicable” where appropriate.

Personal Information

Places of residence for the last ten (10) years

Former and current residences outside of Florida that you have maintained at any time during adulthood


List all postsecondary educational institutions attended:

Employment History

If “Yes”, identify the position(s), the name(s) of the employing agency, and the period(s) of employment:

If “Yes”, state the office title, date of election or appointment, term of office, and level of government (city, county, district, state, federal):

If your service was on an appointed board(s), committee(s), or council(s):

If “Yes”, list:

If “Yes”, list:

List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate.

Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s).

Copyright 2017 Florida Developmental Disabilities Council, Inc. | Powered and Designed by 3W Studios