Application-Burgess, Jason CDB, BMRC & CEB CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check (Ai) the box beside each Board or Committee that you are applying to serve on. If you check more than
one, please rank your interest in each board / committee by order of priority.
(A summary of each board /committee is available on page 2 of this form.)
3 Code Enforcement Board 1 Community Development Board
Pension Board of Trustees 2 Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: 15 June 2011 APPLICANT'S NAME: Jason A. Burgess
ADDRESS: 790 Paradise Lane, Atlantic Beach, Florida 32233
DAYTIME PHONE: (904) 521 -9868 EVENING PHONE: (904) 521 -9868
E -MAIL ADDRESS: iasonna iasonaburgess.com FAX: (904) 981 -8015
Please explain any employment experience, board /committee experience, and/or community volunteer experience
relative to the board/committee applying for.
I do not have specific experience related to the committees but do have substantial experience on other committees
and boards that I have served on in the past and still currently serve on. The past year I have been secretary of the
Jacksonville Bankruptcy Bar Association and have been elected to serve as the treasurer for the upcoming year. In
the past I have also served on the Northern District of Florida Rules Committee and was the lone creditor
representative selected. I am 29 years old and have been involved in the legal community since 2004 and actively
practiced law since 2007. I have routinely been one of the youngest professionals in my field and feel that I have
built up my reputation fairly quickly for being not only a hard worker but a dedicated professional. I believe that my
previous and current board/committee experience will help me work with all types of personalities to do what is best
for the community as a whole. Also my age and experience may bring in a different view to the committees.
Please provide a brief explanation of your interest or any special qualifications you have in this field and your reasons
for wishing to be appointed to this board /committee.
I would say that my legal background could be of particular help with the committees. I am interested in the
committees because I love Atlantic Beach. I want the area to not only stay as beautiful and inviting as it is today but
to only get more beautiful and inviting. I want to do whatever is possible to contribute to the community and hope
my skills and experiences can be used to help Atlantic Beach continue to be the desired area of Florida it is today.
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233 Received
PLEASE NOTE: This application will expire two (2) years after date of submittal. JUN 1 61
1
Office of City Clerk