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Home My WebLink About2020 12 15 Douglas, Wayne Application to Vet Board CITY OF WINTER SPRINGS, FLORIDA INTERESTED IN SERVING YOUR COMMUNITY? BECOME A BOARD/COMMITTEE MEMBER The City of Winter Springs City Commission is always interested in citizens who might like to serve on one of the City's Boards and Committees, which provide assistance to the City Commission. There are several active Boards and Committees that citizens may join, and from time to time other Ad Hoc Advisory Committees are organized; thus new members are often needed. Currently, the City's Boards and Committees open to applicants include: ➢ Bicycle and Pedestrian Advisory Committee ➢ Board Of Trustees ➢ Code Enforcement Board ➢ Districting Commission (Every 3 Years) ➢ Oak Forest Wall And Beautification District Advisory Committee ➢ Parks And Recreation Advisory Committee ➢ Planning And Zoning Board/Local Planning Agency ➢ Tuscawilla Lighting And Beautification District Advisory Committee ➢ Veteran and Veteran Family Advisory Committee This City is fortunate that it has so many caring citizens who continuously give back to their community by serving on boards or committees. The City Commission, City Staff, and their fellow citizens always appreciate the service of these wonderful and caring citizens. From time to time, vacancies may arise on the City's boards and committees, or new ad hoc committees may be established.The City Commission is always interested in finding residents who would like to participate on such a board or committee and do their part to serve their community. Usually, these boards and committees meet once a month or quarterly, and such service generally only requires a few hours of one's time. However, for this little effort,the rewards are great, as citizens have the opportunity to serve the City Commission, meet new members of the community, learn more about the City, and work alongside the City's professional and technical Staff. The Mayor and City Commission appoint members of these boards and committees, except as provided by City Code. If you are interested in serving your community by becoming a member of a board or committee, please contact the Office of the City Clerk for more information and to request an Application at 407-327-5999, or visit the City's website and download the Application. CITY OF WINTER SPRINGS APPLICATION FOR APPOINTMENT TO CITY BOARD/COMMITTEE Applications may be submitted in person at City Hall, facsimile (407-327-4753), or email, � � ni ��llp��lle�� pp�� u�� m��l�� iiii�� u `�iiniiwn� � llaii��)• Applicants may attach a resume, references, recommendations,or other such documentation that the applicant desires to have the City Commission consider. Please be aware that documents submitted to the City are public records available for inspection to the extent allowed by Chapter 119, Florida Statutes. Please complete the following in the space provided: A. GENERAL 1. Name: ", ) � �° i 60 c 2. Home Address -2.. � ��°"- 3. Occupation: ' 4. Telephone(cell):2, ,I, �� '°"� � Telephone (other): 5. Email: e)y B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City board or committee: 1a. Are you duly registered to vote in Seminole County: (N) 1 b. Are you duly registered to vote in the City of Winter Springs? Y (N) 2a. Do you live within the City limits of Winter Springs: (N) 2b. What district do you reside in? (1) (2) (3) (4) (5) 2c. How long have you been a resident of the city? � 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y) 4a. Do you presently serve on any other City of Winter Springs board or committee? Y 4b. Please list each: 5. Do you have any private or personal interests which might conflict with serving the City's interests, if you were to be appointed to serve on this board or committee? (Y) 6. - City ordinance requires that all persons applying for a City board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a standard background check being performed on you by the City of Winter Springs? (N)_ (N) 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y) 6b. If yes to 6a, please provide relation: C. INTEREST AND EXPERIENCE Please see attached descriptions for each of the following boards or committees and indicate below on which board or committee you wish to serve. Please indicate your preference with a one (1) indicating your first choice and rank any additional choices with successive numbering. 1. Please indicate to which board or committee you are applying: Bicycle and Pedestrian Advisory Committee Board of Trustees Code Enforcement Board Districting Commission (every 3 years, 2016) Oak Forest Wall and Beautification District Advisory Committee Parks and Recreation Advisory Committee Planning and Zoning Board/Local Planning Agency T'pacawilla Lighting and Beautification District Advisory Committee Veteran and Veteran Family Advisory Committee Other/Ad Hoc Committee 2. Briefly state why you are interested in serving on this board or committee (attach additional sheets as needed interested in more than one Board): VF 3. Briefly state any specialized knowledge or prior experience you have that would be useful in assisting the board or committee in accomplishing its purpose (attach additional sheets as needed if interested in more than one board):�� '�� 4. Briefly state any experience you have in serving on any governmental board or committee: D. STATE REPORTING REQUIREMENTS Florida law requires that the City annually submit a report to the Secretary of State disclosing race, gender, and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian-American Female Hispanic-American Not Known Native American Caucasian DISABILITY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS UNDER PENALTIES OF PERJURY THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS, AND THE FLORIDA SUNSHINE LAW, WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY BOARD OR COMMITTEE. IF APPOINTED IT IS YOUR SOLE OBLIGATION AND DpTY TO QQMPLY WITH SUC / 1WS. � " � �� Signature: Date: . Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708 2799 Revised 08/13/2020