HomeMy WebLinkAbout20240603 App - Gail HartCity of Cape Canaveral
100 Polk Avenue — P.O. Box 326
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: Gail Hart
Home Address: 5530 Simpaon Place, Cocoa, FL 32926
Phone Number: 321-544-0051
Occupation: Global Strategic Communications
Business Phone: 321-783-2720 x30301
Business Address: 8600 Astronaut Blvd, Cape Canaveral, FL 32920
Email: ghart@acuityinternational.com
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? 0 Yes 0 No
2. Have you been a resident of the City of Cape Canaveral for 12 months or longer? 0 Yes B No
3. Do you own/operate a business in the City of Cape Canaveral? 0 Yes IN No
a. If yes, please list the name:
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 0 No
5. Do you presently serve on any other City of Cape Canaveral advisory board or committee?
❑Yes ElNo
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? ® Yes 0 No
Initials: GSH
7. Are you related to a City of Cape Canaveral Council Member by blood, adoption, or marriage?
❑Yes ElNo
a. If yes, please provide name(s) of person(s) and relationship to you:
City of Cape Canaveral Advisory Board Application (Rev. 03/24) Pg. 1
INTEREST/EXPERIENCE
1. Briefly state your interest in serving on a City advisory board or committee: Members of the Cape Canavera
business commuity since 1999, I represent outreach for Acuity International (legacy Comprehensive Health S‘
2. Please indicate the advisory board(s) on which you wish to serve:
• Board of Adjustment*
• Business and Economic Development Board
❑ Community Appearance Board
❑ Culture and Leisure Services Board
❑ Planning and Zoning Board*
* Members of these boards are required to complete and electronically file, with the State of Florida
Commission on Ethics, a Financial Disclosure Form within 30 days of appointment to said board and prior
to July 7 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: I currentiyserveas
an Executive Board Member of the Space Coast EDC and Communications Director of the Women In Defense Space Coast Chapter BOD.
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. Marketing Communications
CHS history in Cape Canaveral: https://spacecoastedc.org/comprehensive-health-services-inc-selects-brevard-county-for-headquarte
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: 0 African American Gender: 0 Male
❑ Asian American ® Female
❑ Hispanic American 0 Other
8 Caucasian
❑ 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 (Rev. 03/24) 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 on file and may be used by the City to consider you for appointment for a
three-year period from date of submission. At the end of three years, a new application will be required
to be considered forappointment or reappointment. You may withdraw your application from
consideration at any time.
• 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:
Gail S. Hart
} Digitally signed by Gail S. Hart
Date: 2024.05.31 13:02:36 -04'00'
Please return to:
City of Cape Canaveral
Office of the City Clerk
P.O. Box 326
Cape Canaveral Florida 32920
Date: 05/31/2024
OFFICE USE ONLY
EgNTT
By:
JUN 0 3 2024
v
Enter Date & Time Received
City of Cape Canaveral Advisory Board Application (Rev. 03/24) Pg. 3