Seth Frohlich
NAME:
CITY 0= MIAiJI! 3ct;CH
AND COMMi ii E ,4PP,rICATION FOP.IJ:
Las Name ~' ~ G First Name IJuddle ,I/ni+tial
HDME ADDR°_SS: {~ r ~~"" ~`, i1 /~ ~~u~l^ ~~qc-~ f L ~ ~Q
Apt No. House No.lStreet City ,(~~ Stante._.. Zip• Co/~den
PHONE: ~~ s'3 Z ~ 3I D ~~ 256-. 1 '{S~l ~!t/L L1P b~ Li~,
Business Name.
Address: _~~
"/ ~M 1 fad
No.
Professional License (tlescrlbe)
Street
Expires'. Attach a copy of the Irertse
Pursuant to Ctty 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 fpr a minimum of six
months; or b) an individual shall demonstrate ownershiplinterest 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~eP No D
. Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Ye~-ec No D
. Are you a registered voter in Miami Beach: Yes (l~rNo D
• (Please circle one): I am now a resident of: Notch Baaeh South Beach Middle Bsac
. I am applying for an appoirttmerrt because I have spacial abilities, knowledge and experience. Please list below:
. Are you presently a registered lobbyist with the City of Miami Beach? Yes D or No~
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that oniv three f31
choices will be observed by the City Clerk's Office. (Regular Boards of City)
D Affordable Housin Adviso Committee ^ Housin Autho
^ Art in Public Plates Committee D Loan Review Committee
^ Beautification Committee ^ Manna Atttho '
D Board of Ad~ttstment" D Miami Beach Commission for 1Nomen
D B Adviso Committee D Miami Beach Cultural Arts Coundl
D C itel f vem®rrts arts O~rersi Commfttee D Miami Beach Sister Cities P ram
p Committee on the Homeless 0 Norman Shores Local Govemmerrt Ne h. tm rovemerrt
D Committee for Qual Education in MB D Parks and Recreation Faciffties Beard
D Commun Deveia merri Advtso D Personnel Board
^ Cammun Relations Boarcl tannin Boartf'
^ Convention Center Atlviso Soard ^ Polite Citizens Relations Committee
O Debennertt Commtttae D Production indu Council
^ Desion Review BaarO' D Public 5 Adviso Committee
D Disabif' Access Committee ^ Sa Commitfae
D Fine Arts Board 0 Sin fe Famti Residential Review Panel
^ Ga ,Lesbian, Bisexual and Transoentier GLBT ^ Sustarnabil' Committee
^ Goff Adviso Cpmmittee p Trans ran Raliabif• & Accountability Committee "TRAC"
^ Health Adviso Commtttee ^ Tra ottation and Parkin Committee
D Health Facilities Autho ' Board D Visihor and Convention Autho
D His nic Affairs Committee ^ Vttaterirom Protection Committee
^ Historic Preservation Beard 0 Youth Center Adviso Board
"Board Required tp File State Disclosure Form
Note. If applying fpr Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center
. uA. i :.I ~ .. v
1 Past service on the Youth CeT~ A vi ~ BQQa~~rd: Yes .' No ~ Years of Service.
2. Presern participation in Youtf~BeTr~rivi~ ~~Qrl(~tiYdren Yes_~ Nc =. if yes, please list the names of your children, their
ages, and which programs, List below
Childs nam=_ ~+ , . - Age: Program.
X .~: - ~
Cnild's name
Position:
City State Zip Code
Ap=_ Program:
Home Work Fax
III vt.f°s~- Pl~su.~~,-~-.r
? ~,~!EP',5A!'_~or~RMS\674P,v AND ~OMMrrTcES\B~ Aooiicanon06260~ N_VC.do:
•~i a'J~ yon °V~' :~°_er ;~'1 V: ~t°:; :' c ielJn\' "e5 ~ 1' V~9S ~Ie2SE explain Ir. oetai~-.
• ~G yoU CJr r2 ntly' nave a VlOlatl~n(Sj ot.C ity o= IJtam; 3eacn copes Yes .. c• No °S. DIeaSE eY,D lair. Ir ^eia l!.
' • Do you currently owe the City o' IJfiam; Beach any money. Yes . or No f vas. exofain in detail
• .ore you currently servinc or ern' Cit}' 3oards a- ::ommittees Yes or N ` vas w~t~or ooardr
• What oryaniz t17n5 it he C,~iiy o' Miami Beach ~:- VDU currently '(pie membersnlF: tr:?
Name: ~q' ~ ~ca~`` Titi>
Name: (~" JJ G11/ Title:
• Lls I grope lee owned or have an
n~,~~~. ~
in, which a located w hin the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes ~~ or Nrhich department?
• Pursuant.to City Cade Section 2-ZS (b): Do you have a parent ^, spouse _, child C, brother C, or
City os Miami Beach? Checl: all that appl}•. Identify the department(s): --
Tne following information is votuMary and Is neither part of your apptiration nor has arty bearing on your considereflon for eppofntmen; I', it
being asked to comply with federal equal opportunity reporting raqutramertts.
Gender:
0 FemaVe
EJth~nic Origin: Check, on=_ only (1 j
JdNYh-te (Not of Hispanic Origin): All peBOns havhtg origins in any of the original peoples of grope, North Africa or the Middle =est.
~/^ African-AmerieanlBlaek (Not of Hiapentc.Ortgin): All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons of Metri~n, Pt~rto {71ran, Cttben, Central or Sotrth American, or other Spanish culture or origin, regardless of race
Asian or Paclfte fslandar: All persons trevirtg origins in any of the original peopL=s of the Far cast, Southeast Asie, the tndfan Subeorrtinen:. or
the Pacific lsiartds. This area irrdudes, for srampk, China, India, Japan, Korea, the PMlipoine Istantls and 3omoa.
J American lntltan or Alaskan Wafiva: All parsons having origins in any of the origmel gaggles of Norlh America, end who maintain
Ctrttural idarttiReation through tribal afilliatlon m commtafity racopnftion.
Physically Ckallenged: Yes D or NoD
Employment Status: Errtptoye~-'Frafired 0 Homemaker ~ Cther
NC-rc: if appofrrtad, you will be required to follow certain taws which apply to city baardfeommMbae membees.
These laws include, but are not litndard tn, the following:
i
o Prohibition from directly or indiracfiy lobbying city personnel (IJlram~ Beach City Code section 2-459)
Prohibition from contrecEin with the (Miami-Dade Count ^ 1
g city y ..ode section ~- 1.1)
o Prohibition from lobbying before boarU/committee you have served on for period of one year attar leaving office (Mram
Beach City Code section 2-26).
c Requirement to disclose certain ftnanaal inUS2sts and gif[s (Mram+-Dade Coumy Code section 2-1 i.1).
(re: CMB Community Development Advisory Committee) prohibition, during tenure and for one year after leaving ofrrce
! from having any irttarest in or receiving any benefit from Community Development Block Orent funds for either voursel`
i or those with whom you have business or immediate family Pies (CFR ~D.611?.
Upon request, copies of these laws may be. ot>tiained from the City Cierl;.
"! here y a -st to try accuracy and truthfulness of the application and have received, read anC will abide b}~ Chapte•
Articl II f the { Cotle "Stantlar ndn~'-for Ctt}~ Officers. Empioyee~ggenc~v M ~be
p^j ^~t~ fr,.o ~ ~c
Ap i P Si nature Date Name o+ Aoohcan~ (~ SAS: GRIN ~;
Please anaeh a copy v' your resume to tnrs aDPltcabor.
N6TE: Aopheation Ili r mare o ie for oeriov o: one r1 ~ arenaar vea:
~ ~~ , 0 2 z
Recervec ir. the Crtv Crehcs office oy Date ;Z00~ ~ontroi N Date l~OD ~~
Name o' Deoun- ^rerk -