HomeMy WebLinkAbout20221102 App - Shawna Taylor (BED 20230117)City of Cape Canaveral
100 Polk Avenue
Cape Canaveral FL 32920-0326
Phone (321) 868-1220 — Fax (321) 868-1248
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:
GENERAL
Applicant Name: Shawna Taylor
Home Address: 7008 Sevilla Ct #504 Cape Canaveral FL 32920
Phone Number: 3212988253
Occupation: Business Owner/Consultant
Business Phone: 3212988253
Business Address: Online
Email: Pslweightloss@yahoo.com
ELEGIBILITY
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? X- Yes 0 No
2. Have you been a resident of the City of Cape Canaveral for 12 months or longer? ® Yes 0 No
3. Are you a Business owner? 0 Yes 0 No
a. If yes, please list the name: Metabolic Weight Loss
4. 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 purposes of this question.
❑ Yes ® No
a. If yes, have your civil rights been restored? 0 Yes X- No
5. Do you presently serve on any other City of Cape Canaveral advisory board or committee?
❑ Yes ® No
a. If yes, please list each:
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 consent to having a standard background check performed on you by the City of Cape
Canaveral? X- Yes ❑ No
Initials: st
7. Are you related to a City of Cape Canaveral Council member by blood, adoption, or marriage?
❑Yes X-No
a. If yes, please provide name(s) of person(s) and relationship to you:
City of Cape Canaveral Advisory Board Application Pg. 1
INTEREST/EXPERIENCE
1. Briefly state your interest in serving on a City advisory board or committee: I believe that the growth and development
of every city relies on the engagement of the cities residents. In addition I think my experience would help with Cape Canaverals growth and development
2. In numerical sequence (1=most interested), please rank the advisory boards on which you wish to serve:
a. 4 Board of Adjustment*
b. 1 Business and Economic Development Board
c. 3 Community Appearance Board
d. 2 Culture and Leisure Services Board
e. 5 Planning and Zoning Board*
* 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: N/A
I served on a non for profit board
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. Ive worked as a consultant
for many business as well as an executive coach
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:
Race: ❑ African American Gender: ❑ Male
❑ Asian American X- Female
❑ Hispanic American 0- Other
❑ Caucasian
X- Other Disability: 0 Physically Disabled
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.
City of Cape Canaveral Advisory Board Application Pg. 2
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 three years from date of submission.
• If you should have any questions regarding the completion of this application, please contact the City
Clerk's Office at (321) 868-1220 ext. 206 or 207.
Signature: xShawna Taylor Date: 10-31-22
Please return to:
City of Cape Canaveral
Office of the City Clerk
P.O. Box 326
Cape Canaveral Florida 32920
OFFICE USE ONLY
RECEIVED
NOV 0 2 2022
Enter Date & Time Received
City of Cape Canaveral Advisory Board Application Pg. 3