HomeMy WebLinkAbout2021 06 18 Ely, Lisa Application City of Winter Springs, FL Boards & Commissions Submit Date:Jun 18, 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 119, Florida Statutes.
Lisa A. Ely
First Name Middle Initial Last Name
1010 Forest Circle
Home Address Suite or Apt
Winter Springs FL 32708
City State Postal Code
What district do you live in?
V District 2
lisaaely@earthlink.net
Email Address
Mobile: (407) 718-0621
Primary Phone Alternate Phone
Retired
Occupation
Which Boards would you like to apply for?
Oak Forest Wall and Beautification District Advisory Committee:Submitted
Eligibility
Are you duly registered to vote in Seminole County?
t. 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
Yes r No
How long have you been a resident of Winter Springs?
34 years
Lisa A. Ely
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
n/a
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
n/a
Interest & Experiences
Why are you interested in serving on a board or committee?
I am interested in serving on the board to get more involved in our community.
Briefly state any specialized knowledge or prior experience you have that would be useful in
assisting the board or committee in accomplishing its purpose.
I have leadership qualities. When I was working, I was a supervisor at a large physician's office.
Briefly state any experience you have in serving on any governmental board or committee.
I have no experience in serving on a governmental board or committee.
Lisa A. Ely
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*
PF Female
02/28/1959
Date of Birth
Do you have a physical disability?
i- 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
Lisa A. Ely