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HomeMy WebLinkAbout2024 11 12 Petrillo, NIcholas ApplicationSubmit Date: Nov 12, 2024 First Name Middle Initial Last Name Home Address City State Postal Code Email Address City of Winter Springs, FL Boards & Commissions Application Form Public Records Profile What district do you live in? District 4 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? 5 1/2 years 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 Nicholas A Petrillo 653 David St Winter Springs FL 32708 firefighterunclenick@comcast.net Nicholas A Petrillo Please upload a copy of one of the following: Military/Veteran ID OR proof of organization serving veterans & your role Do you currently serve on any other City of Winter Springs board or committee? Yes No 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 Question applies to Veteran and Veteran Family Advisory Committee Interest & Experiences Why are you interested in serving on a board or committee? I am interested because I want to become more active in my 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 am a currently serving Army Reservist and a former military musician. I have knowledge of customs and courtesies for military events. Nicholas A Petrillo Date of Birth Briefly state any experience you have in serving on any governmental board or committee. I am a former volunteer firefighter for my hometown in New Jersey. I have served as the Captain of that department and have served on many committees within the community at planning huge community events. This includes family oriented to veteran events. Financial Disclosure Requirement State Reporting Requirements Ethnicity * Caucasian/Non-Hispanic Gender * Male Do you have a physical disability? Yes No 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 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 Acknowledgment 09/26/1984 Nicholas A Petrillo Please Agree with the Above You agree that you have read and understood the above and further agree to comply with noted requirements. I Agree Nicholas A Petrillo