Art Gonzalez
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: Gonzalez Art J
Last Name First Name Middle Initial
HOME ADDRESS: 750 West 50 Street Miami Beach FL 33140
No. Street City State Zip Code
PHONE: 305-308-2982 305-308-2982 usaart@yahoo.com
Home Work Fax Email address
Business Name: Position:
Address: FL
No. Street City State Zip
Code
Professional License (describe) Expires: Attach a copy of the license
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city.
Yes
? Resident of Miami Beach for a minimum of six (6) months:
No
? Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months:
Yes
? Are you a registered voter in Miami Beach:
Middle Beach
? (Please circle one): I am now a resident of:
No
? Are you a politically or registered lobbyist with the City of Miami Beach:
? I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
123Please note that only three (3)
Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice.
choices will be observed by the City Clerk’s Office.
(Regular Boards of City)
Affordable Housing Advisory Committee Historic Preservation Board*
Art in Public Places CommitteeHousing Authority*
Beach Preservation BoardLoan Review Committee*
Beautification Committee Marine Authority*
Board of Adjustment*Miami Beach Commission for Women
Budget Advisory CommitteeMiami Beach Cultural Arts Council
Capital Improvements OversightMiami Beach Florida Sister Cities
Committee on Homeless Normandy Shores Local Gov’t Neigh. Improvement
[3]
Committee for Quality Education in MBParks and Recreation Facilities Board
Community Development Advisory* Personnel Board*
Community Relations Board Planning Board
Convention Center Advisory BoardPolice Citizens Relations Committee
Cultural Arts Neighborhood District Overlay (CANDO) Production Industry Council
[2]
Debarment CommitteePublic Safety Advisory Committee
Design Review Board*Safety Committee
Disability Access Committee Single Family Residential Review Panel
Fine Arts Board Sustainability Committee
Gay Business Development Ad HocTransparency Reliability & Accountability Committee “TRAC”
[1]
Golf Advisory Committee Transportation and Parking Committee
Health Advisory CommitteeVisitor and Convention Authority*
Health Facilities Authority Board Youth Center Advisory Board
Hispanic Affairs Committee
*
Board Required to File State Disclosure form
C:\Documents and Settings\clerhatl\Local Settings\Temporary Internet Files\1OLK95 \BCAppArtGonzalez5_5_2009121140PM.docx
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
No
1. Past service on the Youth Center Advisory Board: Years of Service:
No
2. Present participation in Youth Center activities by your children? . If yes, please list the names of your children, their ages,
and which programs. List below:
Child’s name: Age: Program:
Child’s name: Age: Program:
No
?Have you ever been convicted of a felony: If yes, please explain in detail:
No
? Do you currently have a violation(s) of City of Miami Beach codes: If yes, please explain in detail:
No
? Do you currently owe the City of Miami Beach any money:If yes, explain in detail
No
? Are you currently serving on any City Boards or Committees: If yes; which board?
? What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
? List all properties owned or have an interest in, which are located within the City of Miami Beach:
750 West 50 Street Miami Beach 33140
No
? I am now employed by the City of Miami Beach: Which department?
?
Pursuant to City Code Section 2-25 (b):
Do you have a who is employed by the City of Miami Beach? Check all that apply.
Identify the department(s):
Gender: Male Race: White
No
Ethnic Origin (Check one) Physically Challenged:
Hispanic
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by
“
Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency
Members."
The City Clerk's Office reserves the right to contact you for verification purposes.
I Art Gonzalez agreed to the following terms on 5/5/2009 12:06:48 PM
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Employment Status: Employed Other:
Received in City Clerk's Office by __________________________________________________________________ Date ____________________
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk’s Office) _____________ Entered By ___________________Date___________________
Revised 09/02/08 LH
C:\Documents and Settings\clerhatl\Local Settings\Temporary Internet Files\2OLK95 \BCAppArtGonzalez5_5_2009121140PM.docx