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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