HomeMy WebLinkAboutcocc_Marlene_Woodside_appl_20190529 CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out an application. City Code also
prohibits a person from serving on a City Board or Committee if that person has been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided:
A. GENERAL ))
1. Applicant Name: '?1 ,C�(UC [ /I`
2. Home Address: 7'„L. � c fQ) 7 G- tlAii r alk
3. Home and Cellular Telephone: 32/ `,j `6 >
4. Occupation: Ric, 7 (/—C 1�
5. Business Telephone:
6. Business Address: �� I
7. E-Mail: kte. C& (f. Carl
B. ELIGIBILITY
The information provided in this section is for purposes of determining whether you are eligible to serve
on a City advisory board or committee.
1. Are you duly registered to vote in Brevard County? (Y) ,/ (N)
2. Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (Y) ✓ (N)
3a. Are you a Business owner: (Y) (N) ✓
3b. If yes to 3a, please list the name:
4a. Have you ever been convicted or found guilty, regardless
of adjudication, or a felony in any jurisdiction? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question. (Y) (N)
4b. If yes to 4a, have your civil rights been restored? (Y) (N)
5a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) (N) ✓
5b. If yes to 5a, please list each:
Page 1 of 3
6. City ordinance requires that all persons applying for a
City advisory board or committee must voluntarily consent
to a standard criminal background check before being
appointed to a board or committee. Do you voluntarily initials
consent to having a standard background check
performed on you by the City of Cape Canaveral? (Y) V (N)
7a. Are you related to a City of Cape Canaveral Council
member by blood, adoption, or marriage? (Y) (N) v'
7b. If yes to 7a, please provide name(s) of person(s) and relationship to you:
C. INTERESTS/EXPERIENCE
1. Briefly state your interest in serving on a City advisory board or committee:
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2. In numerical sequence (1 = most interested), please rank which advisory board or committee
on which you wish to serve:
a. Board of Adjustment*
b. Business and Economic Development Board
c. Code Enforcement Board*
d. _i- Community Appearance Board
e. Construction Board of Adjustment and Appeals*
f. i' Culture and Leisure Services Board
g. Library Board
h. Planning and Zoning Board* T�p2,
Other: u._,.'te l) t2.9 U EN-)cy A5 1i LU
*Members of these boards are required to complete and file with the supervisor of Elections a Financial
Disclosure Form upon appointment to said board and prior to July 1 of each year following the initial
appointment while still a member of said board.
3. Briefly state any prior experiences in serving on any governmental board or committee:
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4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.)
that you feel help to qualify you for membership on the desired board or committee.
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D. STATE REPORTING REQUIREMENTS
Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State
disclosing race, gender, and physical disabilities of board and committee members. Please check the
appropriate boxes:
Page 2 of 3
RACE GENDER
African-American Male
Asian-American Female
Hispanic-American Not Known
Native-American
Caucasian DISABILITY - Gti L y f 5i7'1t L feoloU e T dJ
Not Known Physically di aVble r'
, 9 66(t ifpflQ
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO RELY
ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS.
PLEASE NOTE:
• Appointment to any City board is subject to City Council approval following a brief interview
before the City Council at a regularly scheduled meeting.
• Your application will remain effective for one year from date of completion.
• If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
C Signature: Date: �
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral Florida 32920
For Office Use Only:
Date application received:
Date Appointed:
Appointed by:
Board Appointed to:
Term Expires:
Page 3 of 3
Marlene is a professional artist with a lifelong passion for the arts. Her works have
been exhibited in juried and non juried shows earning many ribbons and awards.
She has also been featured in various publications and in 1999 her design was
selected for the Melbourne Beach founder's day T-Shirt.
Over the years Marlene has been very active in local art organizations including the
Brevard Watercolor Society and the Central Brevard Art Association. In 1997 she
was one of the founders of the Strawbridge Art League in Melbourne, Florida.
A second passion has been Marlene's love for the town of Cape Canaveral. It was
love at first sight when she and her family relocated to this area in 1965. When the
town voted to establish a beautification board she was one of the first volunteer
members and was awarded a key to the city in 1989 for her efforts. Her spirit of
volunteerism continues as a member of the culture and leisure services board and
her advocacy for the advancement of the arts in her community.