Ladislao L. Csinosm MIAMIBEACH
NAME:
HOME ADDRESS
PHONE: ~~!!~
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Last Name m First Name M~ le Initi I
Apt No. House No./Street City tate Zip Cod
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Home
Fax
Business Name: /y/~'T Position:
~,
Address:
No.
Professional License (describe)
Street
Email address
State Zip Code
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.
• Resident of Miami Beach for a minimum of six (6) months: Yes r~or No ^
• Demonstrate an ownership/interest in a business in Miami Bach for a minimum of six (6) months: Yes ^ or No ~
• Are you a registered voter in Miami Beach: Yes ^ or No (~
• (Please circle one): I am now a resident of: North Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No B~
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Authorit
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee ^ Marine Authori
^ Board of Ad'ustment* ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council
^ Ca ital Im rovements Pro'ects Oversi ht Committee ^ Miami Beach Sister Cities Pro ram
^ Committee on the Homeless ^ Normand Shores Local Government Nei h. Im rovement
^ Committee for Quali Education in MB ^ Parks and Recreation Facilities Board
^ Communi Develo ment Adviso ^ Personnel Board
^ Communi Relations Board ^ Plannin Board*
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Debarment Committee ^ Production Indust Council
^ Desi n Review Board* f~"public Safe Adviso Committee
^ Disabili Access Committee ^ Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabili Committee
^ Golf Advisor Committee ^ Trans arenc Reliabili & Accountabili Committee "TRAC"
^ Health Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Facilities Authori Board ^ Visitor and Convention Authori
^ His anic Affairs Committee ^ Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
*Board Required to File State Disclosure Form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes ^ No ^ Years of Service:
2. Present participation in Youth Center activities by your children Yes^ No ^. 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:
City
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc
~~
.Have you ever been convicted of a felony: Yes ~ or No I~' f es le
y , p ase explain in detail:
• Do you currently have a violations} of City of Miami Beach codes: Yes ^ or No t~'If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ~ or No !~. If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ^ or No q/If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in? ,~~n,~,~
Name:
Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
No ~ ~
• I am now employed by the City of Miami Beach: Yes ^ or Nor!Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): , )`~
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: Cy7" Male ^ Female
Ethnic Origin: Check one only (1)
^ White (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
^ frican-American/Black (Not of Hispanic Origin}: All persons having origins in any of the Black racial groups of Africa.
~ispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
^ Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
^ American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
Cultural identification through tribal affiliation community recognition.
Physically Challenged: Yes ^ or No~
Employment Status: Employed ^ Retired ^ Homemakers Other ^
NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office,
from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself ,
or those with whom you have business or immediate family ties (CFR 570.611).
Upon request, copies of these laws may be obtained from the City Clerk.
"I hereby atte t to t accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Arts le VII the ~ Code " rds of Conduct for City Officers, Employees and Agency Members."
icant's Signature Date ame of App scant (PLEASE PRINT) ~ ~
Please attach a copy of your resume to this application
NOTE: Applications wilt remai on file for a period of one (1) calendar year. /
Received in the City Clerk's Office by : ~ ~•c Date: _/ /2009 Control No~_~~ate~ / 009' d
Name of Deputy Clerk
August 12, 2009
To: CITY OF MIAMI BEACH
This is to support the desire of Lukas Csinos to be a mem-
ber of the Safety Committee of the City of Miami Beach. He has
been a member and I know that he took his responsibility very
seriously and would again.
The
~;n~Prely yours„
.. hompson
;~:;~~ ey~ s CYPtlHIA M. LEE
;,,; __ ,: MY .r,OMMISSION # DO 887737
M:, ~, EXPIFES: September 7, 2013
~~;op. F;,;.~' Bonded Tnru Notary Public UrMervrtiters
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God is still speaking,
m N,IA,MIBEACH
Human Resources and Risk Management
TO: To Whom It May Concern
FROM: Ronald Caplan
Safety Officer
DATE: March 8, 2007
SUBJECT: SAFETY COMMITTEE MEMBER
MEMORANDUM
Mr. L. Lukas Csinos Jurko has been an active member of The City of Miami Beach Safety
Committee since October 10, 2002. He has been extremely productive and helpful with all
committees' functions.
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CITY OF 1VILa1~1I BEACH
OFFICE OF RISK;tiI.4rAGENIENT
DATE: August 10, 2006
FROM: ;ton Caplan
Safety Officer
SUBJECT: SAFETY COl~ii~1ITTEE NIEtiIBER
To whom it may concern;
Mr. Ladislao Lukas Csinos 3urko has been an active member of the City of P~iiami Beach
Safety Committee since October 10, 2002. He has been extremely productive and helpful
with all committees' functions.
Si ely,
Ron Caplan ~
Safety Officer