HomeMy WebLinkAbout2020 11 12 Nussbaum, Arnie Application.pdfSubmit Date: Nov 12, 2020
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?
Arnie Nussbaum
687 Andover Circle
Winter Springs FL 32708
arnlee687@aol.com
(407) 359-0849
Arnie Nussbaum
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?
Briefly state any specialized knowledge or prior experience you have that would be useful in
assisting the board or committee in accomplishing its purpose.
Briefly state any experience you have in serving on any governmental board or committee.
State Reporting Requirements
Arnie Nussbaum
Date of Birth
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 *
None Selected
Gender *
Male
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
Arnie Nussbaum