HomeMy WebLinkAboutRecommendation to City Council - Potential Board MembersTO: Bennett Boucher, City Manger
Susan Stills, City Clerk
FROM: Susan Chapman, Secretary, Board of Adjustment
DATE: March 30, 3009
RE: Recommendation to City Council
Board of Adjustment
Three Potential New Board Members
At the Board of Adjustment meeting held on March 16, 2009, the
Board interviewed three potential new board members as follows:
Linda Brown, Douglas Raymond, and Leo Nicholas.
Following the interview and brief discussion, the Board agreed that all
applicants were excellent candidates to sit on the Board as members.
The Board members unanimously recommended that all three
candidates be appointed to the Board. Further, the applicants should
be seated on the Board in the order of their application submittal date.
Ca et< aUl/i�laY
IE0E0V0 2—
JUL
JUL 1 a 2008
C
CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BO RD OR COMMITTEE (J
Pursuant to Section 2-171, Cape Canaveral Co e
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: I—i ljz)A
2. Home Address: �� `%/ ,L� �Civ�. D-43.
3. Home Telephone: \_303/. 79',7. 45�6
4. Occupation: �1112-2
S. i3usiness Telephone: 6 11 &W 'il?d 3
6. Business Address: f bhe; lerhofina./, cow+
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?
2. Have you been a resident of the City of Cape
Canaveral for 12 months or longert
3a. 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.
3b.
4a.
If yes to 3a, have your civil rights been restored?
Do you presently serve on any other City of Cape
Canaveral advisory board or committee?
4b. If yes to 4a, please list each:
(Y) (N)
(Y)(N)
(Y) (N)L'
5. 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 G?.Q
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} (N)
6a. Are you related to a City of Cape Canaveral Council
member by blood, adoption or marriage? {Y) (N)
6b. If yes to 6a, please provide name(s) of person(s) and relationship to you:
C. INTERESTSIEXPERIENCE
9. Briefly state your Interest in serving on a �C�ity advisory board or committee:
!uc' Gn� �du fif 7`y1 Y &Wel- ev-)e c33%Cxtld Gcv�7ri�u
2. Briefly state any prior experiences in serving on any governmental bpa d or committee:
.��1�s�
3. 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
4.
In numerical sequence (1 = most interested), please rank which advisory board or
committee on which you wish to serve:
Wernbers of these boards are required to complete and file with the Supervisor of €fections a
Finanr_iat r�icrin�arm Fnrm {Trn_nn ern-rn-�rntrrprsr nt to said board -and prior- t- vtuty 1 of ac
h y ai
, � w , e
following the initial appoinirnent while stilt a mem sad of said board.
rr eyZaii'ti,i R.Yd
b.
Board of Adjustment*
c.
3
Business and Cultural Development Hoard
d._
Code Enforcement Board*
e.
Community Appearance Board*
f.
Construction Board of Adjustment and Appeals*
9-
f ihrary Rnnrrl
h.
{i�
Planning and Zoning Board*
i.
Recreation Board
}.Other.
Wernbers of these boards are required to complete and file with the Supervisor of €fections a
Finanr_iat r�icrin�arm Fnrm {Trn_nn ern-rn-�rntrrprsr nt to said board -and prior- t- vtuty 1 of ac
h y ai
, � w , e
following the initial appoinirnent while stilt a mem sad of said board.
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:
RACE
GENDER
African-American
Whale
Asian -American
Female
Hispanic -American
Not Known
Native American
Caucasian
DISABILITY
Not Known
Physically disabled
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTIES 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:
Initial appointment to any CIty board is subject to City Council approval following a brief
interview before the City Council at a regularly scheduled meed. -Q.
Your application will remain effective for one year from the date of completion.
If you should have any questions regarding the completion of this application, please
contact the City Cleric's Office at (329) 868-1229.
Signature:
Date: L14e %0 , oho o
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral, Florida 32920
OCT 9 2008
CITY OF CAPE CANAVERAL_
APPLICATIONFOR APPOINTMENT TO CITY ADVISORY BOARD�-R COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
f:
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:_
2. Home Address:
3- Home Telephone:
,
4. Occupation:_---- &9 7-
S. Business Telephone:
6, Business Address:
B. ELIGIBILITY
The information provided in this section is for purposes of determining whether you are eligible
to serve an a City advisory board or committee.
1. Are you duly registered to vote in Brevard County? (Y) / -j
(NJ_
2. Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (Y)-Z(N)_
$a. 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. (Y)_ (N
3b. If yes to 3a, have your civil rights been restored? (Y) (N)_
4a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y)_ (N) -
4b. If yes to 4a, please list each:
5, 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)_Z(N)_
6a. Are you related to a City of Cape Canaveral Council
member by blood, adoption or marriage?, (Y)_ (N)_Z-
6b. If yes to 6a, please provide name(s) of person(s) and relationship to you:
C. 1INTERESTSIEXPEFUENCE
I. . Briefly state your Interest in serving on a City,advisory board or committee:
2. Briefly statea7y prior experiences in serving on any governmental board or committee:
3.
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
In numerical sequence (I = most interested), please
committee on which you wish to serve:
a.
-
Beautification Board
b.
Board of Adjustmenr
C.
Business and Cultural Development Board
d.
Code Enforcement Board*
0.
Community Appearance Board*
Construction Board of Adjustment and Appeals*
Library Board
h.
Planning and Zoning Board*
I.
Recreation Board
j.
Other,
or
*Members of these boards are required to complete and file with the Supervisor of Elections a
Financial Disclosure Fon" upon appointment to sold board and prior to July I of each year
following the initial appointment while still a member of said board.
D- STATE REPORTING REQUIREMENTS.
Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary
of State disclosing race, gander and physical disabilities of board and committee members.
Please check the appropriate boxes:
RACE GENDER
African-American Male
Asian -American Female
Hispanic -American Not Known
Native American
Caucasian DISABILITY
Not Known Physically disabled
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTIES 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 ACKNOWLED43E 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.
41 Initial 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 the date of completion.
If you should have any questions regarding the completion of this application, please
contact the City alakKs Mice at (321) 868-1221.
Signature., A
Date:
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral, Florida 32920
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.- Z- 2-0 ^/,1 C /'/01-,A "
2- Home Address:
1444-1?-o "Z- 0 I /L
3. Home Telephone: 2 2-/ — 2CP3 - 'F,g
4. Occupation:
5. Business Telephone:
6. Business Address:
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?
(N)_
2.
Have you been a resident of the City of Cape
Canaveral for 12 months or longer?
1X I
(Y)__!�_ (N)_
3&
Have you ever been convicted or found guilty, regardless
of adjudication, of a felony in any jurisdiction? Any plea
of noto contendere (no contest) shall be considered a
for
conviction purposes of this question.
(Y)_ (N)- L -Z
3b.
If yes to $a, have your civil rights been restored?
(Y)_ (N)
4a.
Do you presently serve an any other City, of Cape
Canaveral advisory board or committee?
(Y)_ (N) e/
4b.
If yes to 4a, please list each:
5. 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?((N)
6a. Are you related to a City of Cape Canaveral Council
member by blood, adoption or marriage? (Y)r_„__, (N}
6b. if yes to 6a, please provide name(s) of person(s) and relationship to you:
C. INTERESTS/EXPERIENCE
I. Briefly state your interest in serving on a City advisory board or committee:
2. Briefly state any prior experiences in serving on any governmental board or committee:
3. 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:
G /n/ L-,69-
4.
JcR
4. In numerical sequencer (1 = most interested), please rank which advisory board or
,committee on which you wish to serve:
a.�
Beautification Board
Ib.
Board of Adjustment'
c.
Business and Cultural Development Board
d.
Code Enforcement Board*
e.
Community Appearance Board*
f.
Construction Board of Adjustment and Appeals*
€t•
Library Board
h.
Planning and Zoning Board*
i.
Recreation Board
J,
Other:
'*Members of these boards are required to complete and file with the Supervisor of Elections a
Financial Disclosure Foran upon appointment to said board and prior to July 1 of each year
followincl the inNai appointment while still a member of said board
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:
RACE, GENDER
African-American c - Male
Asian -American Female
Hispanic -American Not Known
Native American
Caucasian DISABILITY
Not Known Physically disabled
YOU HERESY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTIES 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 1112.311-.326, FLORIDA STATUTES] AND THE FLORIDA
"SUNSHINE LAW a [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:
• Initial 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 the date of completion.
If you should have any questions regarding the completion of tills application, please
contact the City Clerk's Office at (321) 888-1221.
Signature:
Data.
Please return to: City of Cape Canaveral
Office of the City Cleric
105 Polk Avenue
Cape Canaveral, Florida 32920