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HomeMy WebLinkAbout2022 11 30 Costin, Gerald Application.pdfSubmit Date: Nov 30, 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? None Selected 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? since 01 May 2015 Gerald E Costin 325 MOHAWK TRL WINTER SPRINGS FL 32708 geraldandcathy@gmail.com Home: (814) 619-9886 Business: (321) 759-2261 Merchandiser (volunteer) Veterans Association of the USS Iowa Gerald E Costin Please upload a copy of one of the following: Military/Veteran ID OR proof of organization serving veterans & your role 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 Question applies to Veteran and Veteran Family Advisory Committee Select one of the following * Veteran of the U.S. military discharged or released therefrom under conditions other than dishonorable If yes to the above, please provide relation Question applies to Veteran and Veteran Family Advisory Committee Interest & Experiences Why are you interested in serving on a board or committee? Concerning Veterans Affairs - I am a 20+ year Veteran who enjoys helping other Veterans when they need it. Concerning Parks and Recreation - I believe that Winter Springs needs to provide more options for teenagers to have social experiences options beyond what they have now Military_ID_Card.pdf Gerald E Costin Date of Birth Briefly state any specialized knowledge or prior experience you have that would be useful in assisting the board or committee in accomplishing its purpose. Concerning Veterans Affairs - I am currently working as a volunteer for the Veterans Association of the USS Iowa as 2nd VP. I am generally the first contact for all inquiries the veterans may have since I have the only Assn phone as the merchandiser. I have had to provide guidance for a service member's passing, benefits, military and health records searches, legal issues involving the VA and less than honorable discharges, Concerning Parks and Recreation - I was born into a Military Family and spent most of my childhood on Army, Air Force and Navy Bases both overseas, Texas and Florida. I got to experience first- hand the American Youth Activities Centers (AYA) and Teen Clubs from both the user and later as a Youth Advisor to a couple of those Clubs. Later when I served in the Navy (1975-1995) I was assigned to Planning Board for Training boards, Physical Training and Coordinator, Safety Boards and once a Command Safety Officer, Morale, Welfare and Recreation Committee, Shipboard At-Sea Fire / Flooding Party and Rescue/Assistance Teams. Served in the US Postal Service (1996-2014), where I was assigned as a Safety Board member from time to time. Briefly state any experience you have in serving on any governmental board or committee. Federal Government only. See above 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 * Other Gender * Male Do you have a physical disability? Yes No 05/07/1956 Gerald E Costin 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 Gerald E Costin Submit Date: Nov 30, 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? None Selected 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? since 01 May 2015 Gerald E Costin 325 MOHAWK TRL WINTER SPRINGS FL 32708 geraldandcathy@gmail.com Home: (814) 619-9886 Business: (321) 759-2261 Merchandiser (volunteer) Veterans Association of the USS Iowa Gerald E Costin Please upload a copy of one of the following: Military/Veteran ID OR proof of organization serving veterans & your role 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 Question applies to Veteran and Veteran Family Advisory Committee Select one of the following * Veteran of the U.S. military discharged or released therefrom under conditions other than dishonorable If yes to the above, please provide relation Question applies to Veteran and Veteran Family Advisory Committee Interest & Experiences Why are you interested in serving on a board or committee? Concerning Veterans Affairs - I am a 20+ year Veteran who enjoys helping other Veterans when they need it. Concerning Parks and Recreation - I believe that Winter Springs needs to provide more options for teenagers to have social experiences options beyond what they have now Military_ID_Card.pdf Gerald E Costin Date of Birth Briefly state any specialized knowledge or prior experience you have that would be useful in assisting the board or committee in accomplishing its purpose. Concerning Veterans Affairs - I am currently working as a volunteer for the Veterans Association of the USS Iowa as 2nd VP. I am generally the first contact for all inquiries the veterans may have since I have the only Assn phone as the merchandiser. I have had to provide guidance for a service member's passing, benefits, military and health records searches, legal issues involving the VA and less than honorable discharges, Concerning Parks and Recreation - I was born into a Military Family and spent most of my childhood on Army, Air Force and Navy Bases both overseas, Texas and Florida. I got to experience first- hand the American Youth Activities Centers (AYA) and Teen Clubs from both the user and later as a Youth Advisor to a couple of those Clubs. Later when I served in the Navy (1975-1995) I was assigned to Planning Board for Training boards, Physical Training and Coordinator, Safety Boards and once a Command Safety Officer, Morale, Welfare and Recreation Committee, Shipboard At-Sea Fire / Flooding Party and Rescue/Assistance Teams. Served in the US Postal Service (1996-2014), where I was assigned as a Safety Board member from time to time. Briefly state any experience you have in serving on any governmental board or committee. Federal Government only. See above 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 * Other Gender * Male Do you have a physical disability? Yes No 05/07/1956 Gerald E Costin 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 Gerald E Costin Submit Date: Nov 30, 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? None Selected Which Boards would you like to apply for? Veteran and Veteran Family 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? since 01 May 2015 Gerald E Costin 325 MOHAWK TRL WINTER SPRINGS FL 32708 geraldandcathy@gmail.com Home: (814) 619-9886 Business: (321) 759-2261 Merchandiser (volunteer) Veterans Association of the USS Iowa Gerald E Costin Please upload a copy of one of the following: Military/Veteran ID OR proof of organization serving veterans & your role 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 Question applies to Veteran and Veteran Family Advisory Committee Select one of the following * Veteran of the U.S. military discharged or released therefrom under conditions other than dishonorable If yes to the above, please provide relation Question applies to Veteran and Veteran Family Advisory Committee Interest & Experiences Why are you interested in serving on a board or committee? Concerning Veterans Affairs - I am a 20+ year Veteran who enjoys helping other Veterans when they need it. Concerning Parks and Recreation - I believe that Winter Springs needs to provide more options for teenagers to have social experiences options beyond what they have now Military_ID_Card.pdf Gerald E Costin Date of Birth Briefly state any specialized knowledge or prior experience you have that would be useful in assisting the board or committee in accomplishing its purpose. Concerning Veterans Affairs - I am currently working as a volunteer for the Veterans Association of the USS Iowa as 2nd VP. I am generally the first contact for all inquiries the veterans may have since I have the only Assn phone as the merchandiser. I have had to provide guidance for a service member's passing, benefits, military and health records searches, legal issues involving the VA and less than honorable discharges, Concerning Parks and Recreation - I was born into a Military Family and spent most of my childhood on Army, Air Force and Navy Bases both overseas, Texas and Florida. I got to experience first- hand the American Youth Activities Centers (AYA) and Teen Clubs from both the user and later as a Youth Advisor to a couple of those Clubs. Later when I served in the Navy (1975-1995) I was assigned to Planning Board for Training boards, Physical Training and Coordinator, Safety Boards and once a Command Safety Officer, Morale, Welfare and Recreation Committee, Shipboard At-Sea Fire / Flooding Party and Rescue/Assistance Teams. Served in the US Postal Service (1996-2014), where I was assigned as a Safety Board member from time to time. Briefly state any experience you have in serving on any governmental board or committee. Federal Government only. See above 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 * Other Gender * Male Do you have a physical disability? Yes No 05/07/1956 Gerald E Costin 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 Gerald E Costin