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HomeMy WebLinkAbout2021 02 22 Thomson, Harold Application for CEB City of Winter Springs, FL Boards &Commissions Submit Date: Feb 22, 2021 Application Form Profile Please be aware that documents submitted to the City are public records available for inspection to the extent allowed by Chapter 1 Florida Statutes. Harold J Thomson First Name Middle Initial Last Name 931 Ginnie Way Home Address Suite or Apt Winter Springs FL 32708 City State Postal Code What district do you live in? District 2 hthomson48@att.net Email Address Mobile: (407) 341-8232 Home: (407) 327-4904 Primary Phone Alternate Phone Retired Occupation Which Boards would you like to apply for? Code Enforcement Board: Appointed Eligibility Are you duly registered to vote in Seminole County? • Yes r No Are you duly registered to vote in the City of Winter Springs? • Yes r No Do you live within the city limits of Winter Springs • Yes r No How long have you been a resident of Winter Springs? 24 years Harold J Thomson Have you ever been convicted or found regardless of of a felony in any guilty, adjudication, jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for the purposes of this question. Yes • No Do you currently serve on any other City of Winter Springs board or committee? Yes • No above,If yes to the 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? Yes • 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? • Yes r No Are you related to a City of Winter Springs Commission member by blood, adoption, or Yes • No If yes to the above, please provide relation Interest & Experiences Why are you interested in serving on a board or committee? would like to contribute to the running of the city Briefly state any specialized knowledge or prior experience you have that would be useful in assisting the board or committee in accomplishing its purpose. have been on the board of the Winter Springs Village HOA as well as an ARC member. Briefly state any experience you have in serving on any governmental board or committee. See above State Reporting Requirements Harold J Thomson Florida law requiresi 1y submit a report to the Secretary of State disclosing , physicalgender, and i iiicommittee Ethnicity* Caucasian/Non-Hispanic Male 05/29/1948 Date of Birth Do you have a physical disability? Yes • 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 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. Agree Harold J Thomson