GOVERNOR'S OFFICE Boards and Appointments Application

Similar documents
GOVERNOR'S OFFICE Boards and Appointments Application

GOVERNOR'S OFFICE Boards and Appointments Application

GOVERNOR'S OFFICE Boards and Appointments Application


GOVERNOR'S OFFICE Boards and Appointments Application

GOVERNOR'S OFFICE Boards and Appointments Application

GOVERNOR'S OFFICE Boards and Appointments Application

Gubernatorial Appointments Form for General Information** Governor s Appointments Office (850) or

GOVERNOR'S OFFICE Boards and Appointments Application

JACKSONVILLE CITY COUNCIL Board and Commission Appointment Application

OFFICE OF THE GOVERNOR

GOVERNOR GREG ABBOTT OFFICE OF THE GOVERNOR APPOINTMENT APPLICATION

TEXAS HIGHER EDUCATION COORDINATING BOARD P.O. Box Austin, Texas 78711

STATE OF FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES

To: Chancellors, Presidents, and Chief Academic Officers of Public Institutions of Higher Education

A BASIC GUIDE TO LOBBYING REGISTRATION AND DISCLOSURE IN THE CITY OF IRVINE. Prepared by the City Clerk March 2006 Updated January 2018

FORM F4 REGISTRATION OF INDIVIDUALS AND REVIEW OF PERMITTED INDIVIDUALS (section 2.2)

UNIFORM JUDICIAL QUESTIONNAIRE

SUFFOLK REDEVELOPMENT AND HOUSING AUTHORITY 530 East Pinner Street, Suffolk, Virginia Phone: Fax:

MUST BE COMPLETED IN FULL.

Attention Applicants

APPLICATION FOR CAPITAL COLLATERAL REGIONAL COUNCIL

State of Florida Department of Business and Professional Regulation Asbestos Licensing Unit Request for Change of Status Form # DBPR ALU 4

CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer

CHAPTER Senate Bill No. 2058

APPLICATION FOR LIQUOR RETAILER S LICENSE / ALCOHOL ON PREMISE LICENSE PART 1

Please mail your completed application, documentation and required fee(s) to: 2601 Blair Stone Road Tallahassee, Fl

City of Waco Application for Police Recruit

EMPLOYMENT APPLICATION Town of Topsham 100 Main Street Topsham, Maine Phone: Fax:

FLORIDA BAR JUDICIAL CANDIDATE VOLUNTARY SELF-DISCLOSURE STATEMENT

APPLICATION FOR NOMINATION TO THE

CITY OF MCLOUTH, KANSAS

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES

APPLICATION For Employment

LAW OFFICES OF CARL SHUSTERMAN Intake Form

City of Lakewood Board of Appeals Appointment Application

Tennessee Trial Court Vacancy Commission Application for Nomination to Judicial Office

CONSTITUTIONAL AMENDMENT (Amendment approved by the voters on November 8, 2011)

SCHOOL DISTRICT OF MARATHON CERTIFIED STAFF EMPLOYMENT APPLICATION

CITY OF SHERIDAN, WYOMING

THE REQUIREMENTS FOR ALCOHOLIC BEVERAGE APPLICATION MUST BE A UNITED STATES CITIZEN ANYONE THAT OWNS 20% OR MORE OF THE BUSINESS +THE MANAGER

Name Home Phone( ) LAST FIRST MIDDLE Cell Phone( ) Address: Address NO STREET CITY STATE ZIP

THE MORTGAGE BROKERS ACT

Last Name First Name M.I. Name You Prefer. City State Zip Address. Daytime Phone Evening Phone Best Time to Call. City State If yes, where?

Completing the Florida Legislature Employment Application

NORCAL Ambulance Employment Application. ( ) - ( ) - Home Phone Cell Phone Address

STATE OF NEW JERSEY OFFICE OF THE ATTORNEY GENERAL DEPARTMENT OF LAW & PUBLIC SAFETY DIVISION OF ALCOHOLIC BEVERAGE CONTROL

ADULT GUARDIANSHIP QUESTIONNAIRE

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPOINTMENT OF A CAMPAIGN TREASURER BY A CANDIDATE

ADULT GUARDIANSHIP QUESTIONNAIRE A. INFORMATION ABOUT THE ALLEGED INCAPACITATED PERSON:

City of Lakewood JUDICIAL REVIEW COMMISSION Appointment Application BACKGROUND INFORMATION. Address: Cell Phone:

EMPLOYMENT APPLICATION FOR SERVICE AND SUPPORT PERSONNEL. Presidio Independent School District. An Equal Opportunity Employer

Last Name First Name Middle Name Social Security Number. Street Address City State and Zip Code. Yes No If not, state Date of Birth

Agape Document Services Unlimited

FLORIDA COUNCIL ON THE SOCIAL STATUS OF BLACK MEN AND BOYS COMMUNITY REPRESENTATIVE APPLICATION

PERSONAL HISTORY QUESTIONNAIRE. Applicant Name:

Keokuk Police Department

Information Regarding Dental Licensure by Regional Examination for In State Applicants

1 of 9. APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your application to ensure faster processing.

Secretary of the Senate Office of Public Records 232 Hart Building Washington, DC

Green Thumb Volunteer Application.

Name Last First M.I. Would you be interested in your application packet being forwarded to the TERO Office to be included in a job

TEXAS BOARD OF PARDONS AND PAROLES FULL PARDON APPLICATION INSTRUCTIONS

CITY OF SAYRE, OKLAHOMA AN EQUAL OPPORTUNITY EMPLOYER

Electronic Travel Authorization

JUDICIAL SELECTION QUESTIONNAIRE

Kingsland Municipal Utility District PO Box 748 Kingsland, Texas Phone (325) Fax (325)

2017 PERSONAL HISTORY QUESTIONNAIRE. Applicant Name: Instructions

Submit photograph of applicant (must be at least 2 x 2 ). Attach photo to application on page provided.

Application for Employment

APPLICATION FOR ENTRY ON OR A CHANGE TO THE LIST OF ELECTORS. Application form by mail, , or fax

Tennessee Athlete Agent Application for Registration or Renewal

PRE-EMPLOYMENT APPLICATION PACKET PAVEMENT SOLUTIONS, LLC

State of Florida Department of Business and Professional Regulation Board of Professional Geologists

TEXAS ETHICS COMMISSION

SECTION A: APPLICANT S PARTICULARS

Michael Gayoso, Jr. Office of the County Attorney TH

DACA (DEFERRED ACTION FOR CHILDHOOD ARRIVALS) QUESTIONNAIRE AND DOCUMENT REQUEST

APPLICATION FOR EMPLOYMENT

FLORIDA BAR JUDICIAL CANDIDATE VOLUNTARY SELF-DISCLOSURE STATEMENT

AMBULANCE LICENSE APPLICATION

Employment Application An Equal Opportunity Employer

CLERK OF THE COURT SUPERIOR COURT OF ARIZONA

JUDICIAL SELECTION QUESTIONNAIRE

STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS

FORM F4 REGISTRATION INFORMATION FOR AN INDIVIDUAL

CITY OF UVALDE. P.O. BOX 799 UVALDE, TEXAS (830) FAX: (830)

Last Name First Name Middle Name. Address:

Employment Application

STATE OF NEW JERSEY PETITION FOR EXECUTIVE CLEMENCY

Petition for Occupational Driver s License

RECALL ELECTIONS. Summary. Procedures

Form I-485, Application to Register Permanent Residence or Adjust Status

FLORIDA BAR JUDICIAL CANDIDATE VOLUNTARY SELF-DISCLOSURE STATEMENT

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

Application for Employment

JEFFERSON COUNTY ATTORNEY S OFFICE Joshua A. Ney, County Attorney

Transcription:

GOVERNOR'S OFFICE As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Mr. First Name Gillis Middle/Maiden Edward Last Name Powell Jr Email Address gillpowell@powelllawfirm.com Cell Phone 850-902-0805 Race Caucasian Gender Male Fax 850-689-1588 Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line 1 451 Mary Esther Parkway Address Line 2 City Mary Esther State County Okaloosa Zip / Postal Code 32569 Phone Number 850-682-2757 3- Business Address Line 1 422 rth Main Street Address Line 2 City Crestview State Zip / Postal Code 32536 Phone Number 850-682-2757 Other Residences 4-A. List all your places of residence for the last ten (10) years. 1 of 6

Personal Information GOVERNOR'S OFFICE Address City & State Start Date End Date 175 Ridge Lake Grove Crestview, Previous 30 Years 451 Mary Esther Parkway Mary Esther, June 2012 Present 4-B. List all your former and current residences outside of that you have maintained at any time during adulthood. Address City & State Start Date End Date Unknown, over 25 years ago while in law school Houston, Texas Approximately 1972 1974 5- Date of Birth 02/24/1947 Place of Birth Crestview 6- Driver License # P400285470640 Issuing State 7- Social Security # s. 119 071(5)(a) F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of? 1947 11- Vote Are you a registered voter? Yes County of registration Okaloosa Current Party Affiliation Democrat Education 12-A. High School Crestview High School Year Graduated 1965 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Auburn University, Auburn, Alabama - 1969 Bachelor of Arts South Texas College of Law - 1974 Doctorate of Jurisprudence Employment 2 of 6

13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge GOVERNOR'S OFFICE 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Start Date End Date Powell, Powell and Powell, P.A. Law Firm Attorney, Partner 1974 Present 15- Have you ever been employed by any state, district, or local governmental agency in? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I have been practicing law for (38) years. I have represented thousands of clients from all walks of life. I am an AV Preeminent Attorney as rated by Martindale- Hubbell, which rates attorneys throughout the country. It is the highest rating an attorney can obtain. My father, Gillis E. Powell, Sr. was an attorney and also a circut court judge before coming off the bench to practice law with me. My grandfather and uncle were attorneys and judges as well. My three children are all attorneys and my two daughters practice law in our firm. My son is employed as an Assistant State Attorney in Santa Rosa County. My wife has a Ph.D. in English Literature. Education is an integral part of my family. I feel like my experience dealing with people for (38) years and advising numerous young peopole on the importance of education that I believe I am well qualified to sit on the Board of Trustees for this fine college. C. Have you received any awards or recognitions relating to the subject matter of this appointment? Yes B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes Doctorate of Jurisprudence D. Identify all association memberships and association offices held by you that relate to this appointment 3 of 6

GOVERNOR'S OFFICE Martindale-Hubbell AV Preeminent Rating (highest possible rating) Client Distinction Award E.E. Townes Award, South Texas College of Law (for scholastic excellence) Cum Laude, South Texas College of Law Phi Alpha Delta Fraternity The Bar Justice Association American Association for Justice 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of? Title of Office Reason of Suspension Date of Suspension Result Please Select 4 of 6

GOVERNOR'S OFFICE 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Office of the State Attorney References & Affiliations Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency Son Employee Office of the State Attorney NWFSC Wife Faculty member NWFSC 28- 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 Senate. 5 of 6

Name Mailing Address Zip Code Phone Number Judge Keithe Brace ret. 5494 Monterrey Road Crestview, 32536 8506829078 Judge William F. Stone 101 James Lee Boulevard Crestview, 32536 8506094700 Richard C. Moulton 2798 Dogwood Acres Crestview, 32536 8503988634 29- 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) Name Mailing Address Office(s) Held & Term Date of Membership CCB Community Bank Regions Bank 1290 rth Ferdon Boulevard Crestview, 32536 2355 South Ferdon Avenue Crestview, 325366 GOVERNOR'S OFFICE Board of Directors 01/01/0001 Board of Directors 01/01/0001 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Education Board Name Seat Seat Qualification Reappointment District Board of Trustees, rthwest State College 2 Okaloosa County 6 of 6