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HomeMy WebLinkAbout2021 01 10 Van Kleunen, James Application (PARAC) City of Winter Springs, FL Boards & Commissions
Application Form
Profile
Please be aware that documents submitted to the City are public records available for
Inspection to the extent allowed by Chapter 119, Florida Statutes.
James M Van Kleunen
11...............................................
First Narne Middle Initial Last Narne
1208 Cheetah Trail
I-lorne Address Suite or Apt
Winter Springs FL 32708
11......................................................................................................
City State Postal Code
What district do you live in?
�W District 3
jvankl@aol.com
Email Address
(407) 383-3667
Primary Phone Alternate Phone
Sales Representative for Pfizer
Oncology...
Occupation
is Boards would you like to apply for?
Parks and Recreation Advisory Committee:Appointed
Eligibility
Are you duly registered to vote in Seminole County?
r Yes r No
Are you duly registered to vote in the City of Winter Springs?
r Yes r No
Do you live within the city limits of Winter Springs
r Yes r No
How long have you been a resident of Winter Springs?
27 years
James M Van Kleunen Page 1 of 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
the purposes of this question.
r Yes r No
Do you currently serve on any other City of Winter Springs board or committee?
r Yes r No
If yes to the above, please list each
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?
r Yes r No
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?
r Yes r No
Are you related to a City of Winter Springs Commission member by blood, adoption, or
marriage?
r Yes r No
If yes to the above, please provide relation
Interest & Experiences
by are you interested in serving on a board or committee?
I have been an active member of the Parks and Recreation Advisory Committee since October of 2013
and have provided advocacy, active input, excellent attendance and stewardship of this valuable resource
that our city offers.
Briefly state any specialized knowledge or prior experience you have that would be useful in
assisting the board or committee in accomplishing its purpose.
During my 27 years as a citizen in Winter Springs and my tenure on this committee, I have worked with
the members and the city representatives to provide valuable insight, ideas and commentary on
maintaining and improving this valuable resource that is available to our community. I was active in
improving the litter situation at Trotwood Park by advocating for additional trash cans in problem areas
and improving the ball fields to prevent standing water and weed overgrowth.as well as advocating for the
now available community garden at the Senior Center
James M Van Kleunen Page 2 of 3
Briefly state any experience you have in serving on any governmental board or committee.
I have until recently served on the Family Advisory Council at Arnold Palmer Hospital for Children.
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.
Ethnicity
�W Caucasian/Non-Hispanic
Gender*
�W Male
08/18/1958
Date of Birth
Do you have a physical disability?
r Yes r No
Please Agree with the Following Statement
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
�W I Agree
Please Agree with the Following Statement
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 duty to comply with such laws.
�W I Agree
James M Van Kleunen Page 3 of 3