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HomeMy WebLinkAbout2022 06 13 Campbell, Sherri Application.pdfSubmit Date: Jun 13, 2022 First Name Middle Initial Last Name Home Address Suite or Apt City State Postal Code Email Address Primary Phone Alternate Phone Occupation 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. What district do you live in? District 2 Which Boards would you like to apply for? Parks and Recreation Advisory Committee: Submitted Eligibility Are you duly registered to vote in Seminole County? Yes No Are you duly registered to vote in the City of Winter Springs? Yes No Do you live within the city limits of Winter Springs Yes No How long have you been a resident of Winter Springs? 2 years Sherri Campbell 844 benchwood ct Winter Springs FL 32708 soupster81@gmail.com Mobile: (407) 483-6934 Home: (407) 696-5157 Financial services representative Sherri Campbell 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. Yes No Do you currently serve on any other City of Winter Springs board or committee? Yes 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? 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 No Are you related to a City of Winter Springs Commission member by blood, adoption, or marriage? Yes No If yes to the above, please provide relation Interest & Experiences Why are you interested in serving on a board or committee? I'm an avid biker and outdoor enthusiast. I would love to help plan and maintain biking paths for families to enjoy. I'm interested in being a more active member of 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've been in leadership roles with the govt (Dhs). I've helped implement and oversee training and planning to achieve goals within my department. Briefly state any experience you have in serving on any governmental board or committee. Na Sherri Campbell Date of Birth Financial Disclosure Requirement 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 * Caucasian/Non-Hispanic Gender * Female 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 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. I Agree 11/12/1981 Sherri Campbell Submit Date: Jun 13, 2022 First Name Middle Initial Last Name Home Address Suite or Apt City State Postal Code Email Address Primary Phone Alternate Phone Occupation 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. What district do you live in? District 2 Which Boards would you like to apply for? Bicycle and Pedestrian Advisory Committee: Submitted Eligibility Are you duly registered to vote in Seminole County? Yes No Are you duly registered to vote in the City of Winter Springs? Yes No Do you live within the city limits of Winter Springs Yes No How long have you been a resident of Winter Springs? 2 years Sherri Campbell 844 benchwood ct Winter Springs FL 32708 soupster81@gmail.com Mobile: (407) 483-6934 Home: (407) 696-5157 Financial services representative Sherri Campbell 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. Yes No Do you currently serve on any other City of Winter Springs board or committee? Yes 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? 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 No Are you related to a City of Winter Springs Commission member by blood, adoption, or marriage? Yes No If yes to the above, please provide relation Interest & Experiences Why are you interested in serving on a board or committee? I'm an avid biker and outdoor enthusiast. I would love to help plan and maintain biking paths for families to enjoy. I'm interested in being a more active member of 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've been in leadership roles with the govt (Dhs). I've helped implement and oversee training and planning to achieve goals within my department. Briefly state any experience you have in serving on any governmental board or committee. Na Sherri Campbell Date of Birth Financial Disclosure Requirement 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 * Caucasian/Non-Hispanic Gender * Female 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 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. I Agree 11/12/1981 Sherri Campbell Submit Date: Jun 13, 2022 First Name Middle Initial Last Name Home Address Suite or Apt City State Postal Code Email Address Primary Phone Alternate Phone Occupation 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. What district do you live in? District 2 Which Boards would you like to apply for? Code Enforcement Board: Submitted Eligibility Are you duly registered to vote in Seminole County? Yes No Are you duly registered to vote in the City of Winter Springs? Yes No Do you live within the city limits of Winter Springs Yes No How long have you been a resident of Winter Springs? 2 years Sherri Campbell 844 benchwood ct Winter Springs FL 32708 soupster81@gmail.com Mobile: (407) 483-6934 Home: (407) 696-5157 Financial services representative Sherri Campbell 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. Yes No Do you currently serve on any other City of Winter Springs board or committee? Yes 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? 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 No Are you related to a City of Winter Springs Commission member by blood, adoption, or marriage? Yes No If yes to the above, please provide relation Interest & Experiences Why are you interested in serving on a board or committee? I'm an avid biker and outdoor enthusiast. I would love to help plan and maintain biking paths for families to enjoy. I'm interested in being a more active member of 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've been in leadership roles with the govt (Dhs). I've helped implement and oversee training and planning to achieve goals within my department. Briefly state any experience you have in serving on any governmental board or committee. Na Sherri Campbell Date of Birth Financial Disclosure Requirement Question applies to Planning and Zoning Board/Local Planning Agency,Code Enforcement Board,Board of Trustees Please Agree with the Following Statement All members of the Board of Trustees, Code Enforcement Board, and Planning and Zoning Board are required to annually file a Form 1 - Statement of Financial Interests. By clicking "I Agree" you are stating you understand and agree to comply with this requirement if appointed to one of these Boards. I Agree 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 * Caucasian/Non-Hispanic Gender * Female 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 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. I Agree 11/12/1981 Sherri Campbell Submit Date: Jun 13, 2022 First Name Middle Initial Last Name Home Address Suite or Apt City State Postal Code Email Address Primary Phone Alternate Phone Occupation 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. What district do you live in? District 2 Which Boards would you like to apply for? Parks and Recreation Advisory Committee: Submitted Eligibility Are you duly registered to vote in Seminole County? Yes No Are you duly registered to vote in the City of Winter Springs? Yes No Do you live within the city limits of Winter Springs Yes No How long have you been a resident of Winter Springs? 2 years Sherri Campbell 844 benchwood ct Winter Springs FL 32708 soupster81@gmail.com Mobile: (407) 483-6934 Home: (407) 696-5157 Financial services representative Sherri Campbell 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. Yes No Do you currently serve on any other City of Winter Springs board or committee? Yes 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? 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 No Are you related to a City of Winter Springs Commission member by blood, adoption, or marriage? Yes No If yes to the above, please provide relation Interest & Experiences Why are you interested in serving on a board or committee? I'm an avid biker and outdoor enthusiast. I would love to help plan and maintain biking paths for families to enjoy. I'm interested in being a more active member of 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've been in leadership roles with the govt (Dhs). I've helped implement and oversee training and planning to achieve goals within my department. Briefly state any experience you have in serving on any governmental board or committee. Na Sherri Campbell Date of Birth Financial Disclosure Requirement Question applies to Planning and Zoning Board/Local Planning Agency,Code Enforcement Board,Board of Trustees Please Agree with the Following Statement All members of the Board of Trustees, Code Enforcement Board, and Planning and Zoning Board are required to annually file a Form 1 - Statement of Financial Interests. By clicking "I Agree" you are stating you understand and agree to comply with this requirement if appointed to one of these Boards. I Agree 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 * Caucasian/Non-Hispanic Gender * Female 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 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. I Agree 11/12/1981 Sherri Campbell Submit Date: Jun 13, 2022 First Name Middle Initial Last Name Home Address Suite or Apt City State Postal Code Email Address Primary Phone Alternate Phone Occupation 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. What district do you live in? District 2 Which Boards would you like to apply for? Bicycle and Pedestrian Advisory Committee: Submitted Eligibility Are you duly registered to vote in Seminole County? Yes No Are you duly registered to vote in the City of Winter Springs? Yes No Do you live within the city limits of Winter Springs Yes No How long have you been a resident of Winter Springs? 2 years Sherri Campbell 844 benchwood ct Winter Springs FL 32708 soupster81@gmail.com Mobile: (407) 483-6934 Home: (407) 696-5157 Financial services representative Sherri Campbell 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. Yes No Do you currently serve on any other City of Winter Springs board or committee? Yes 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? 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 No Are you related to a City of Winter Springs Commission member by blood, adoption, or marriage? Yes No If yes to the above, please provide relation Interest & Experiences Why are you interested in serving on a board or committee? I'm an avid biker and outdoor enthusiast. I would love to help plan and maintain biking paths for families to enjoy. I'm interested in being a more active member of 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've been in leadership roles with the govt (Dhs). I've helped implement and oversee training and planning to achieve goals within my department. Briefly state any experience you have in serving on any governmental board or committee. Na Sherri Campbell Date of Birth Financial Disclosure Requirement Question applies to Planning and Zoning Board/Local Planning Agency,Code Enforcement Board,Board of Trustees Please Agree with the Following Statement All members of the Board of Trustees, Code Enforcement Board, and Planning and Zoning Board are required to annually file a Form 1 - Statement of Financial Interests. By clicking "I Agree" you are stating you understand and agree to comply with this requirement if appointed to one of these Boards. I Agree 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 * Caucasian/Non-Hispanic Gender * Female 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 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. I Agree 11/12/1981 Sherri Campbell