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HomeMy WebLinkAbout2021 10 24 Arok, Zoltan Application.pdfSubmit Date: Oct 24, 2021 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 3 Which Boards would you like to apply for? Tuscawilla Lighting & Beautification District 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? 25 years Zoltan Arok 1104 Pheasant Cir Winter Springs FL 32708 zarok@cfl.rr.com Home: (407) 766-6996 Home: (407) 699-1157 Technical Sales Johnson Controls Zoltan Arok 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 TLBD 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 wish to volunteer where I can to help towards the betterment of Winter Springs 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. -Tuscawilla Lighting and Beautification -Previously served on Winter Springs Districting Committee - State Reporting Requirements Zoltan Arok 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 * Caucasian/Non-Hispanic 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 01/21/1960 Zoltan Arok