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Jay E. Reinberg Board Application & Resume E- /V l i /'U 1 I b tAL 1 I CITY OF MIAMI BEACH Reinberg, Jay E . BOARD AND COMMITTEE APPLICATION FORM NAME; Last Name First Name Middle Initial HOME ADDRESS: 3105 Sheridan Avenue 33140 Apt No. House No. /Street City State Zip Code PHONE: n/a 305 932 - 9880 n/ Horne Work Fax Email address Suite 2070 Doctor Business Name: Position: Address: 4302 Alton Road, Miami Beach 33140 No. Street City State Zip Code State of Florida ME 65783 Professional License (describe) Expires: Attach a copy of the license MDL) !CAL DOCTOR 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 aty for a minimum of six months; or b) an individual shall demonstrate ownership/interest for minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months: Yes or No 0 • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes o r No 0 • Are you a registered voter in Miami Beach: Yes 0 or No 0 • (Please circle one): I am now a resident of: North Beach South 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 0 or No ❑ Please list your preferences In order of ranking [1) first choice [2] second choice, and [3] third choice. Please note that only three (31 choices will be observed by the Clty Clerk's Office. (Regular Boards of City) 0 Affordable Housing Advisory Committee ❑ Marine Authority ❑ Art in Public Places Committee ❑ Miami Beach Commission for Women 0 Beautification Committee 0 Miami Beach Cultural Arts Council D Board of Adjustment* ❑ Miami Beach Human Rights Committee 0 Budget Advisory Committee 0 Miami Beach Sister Cities Program ❑ Capital Improvements Projects Oversight Committee ❑ Normandy Shores Local Government Neigh. Improvement 0 Committee on the Homeless ❑ Parks and Recreation Facilities Board 0 Committee for Quality Education In MB ❑ Personnel Board 0 Community Development Advisory ❑ Planning Board* 0 Community Relations Board 0 Police Citizens Relations Committee 0 Convention Center Advisory Board 0 Production Industry Council 0 Debarment Committee 0 Public Safety Advisory Committee _ 0 Design Review Board* 0 Safety Committee 0 Disabili Access Committee ❑ Sincle Fern' Residential Review Panel 0 Fine Arts Board 0 Sustainabifity Committee 0 Gay, Lesbian, Bisexual and Transgender (GLBT) 0 Transportation and Parking Committee , 0 Golf Advisory_Commlttee 0 Visitor and Convention Authority kXHealth Advisory Committee D Waterfront Protection Committee 0 Health Facilities Authority Board 0 Youth Center Advisory Board 0 Hispanic Affairs Committee 0 Historic Preservation Board 0 Housing Authority 0 Loan Review Committee `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 0 No 0 Years of Service: 2. Present participation in Youth Center activities by your children Yesc No 0. 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: _ ,C1LER'_SALL \aFOkMS \BOARD ANC COMMITEES \Br' Acpllcation - doc 11 k i { it 1 a •Have you ever been convicted of a felony: Yes 0 or No L yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No LF yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes 0 or No P . yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes 0 or No 291f yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? Name: T Name: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: 3105 Sheridan Avenue • I am now employed by the City of Miami Beach: Yes o or Noff department? n/a • Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister o who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): The following tnformatfon is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. tt is being asked to comply with federal equal opportunity reporting requirements. Gender. 1 /tale 0 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 Muddle East 0 African- AmericaniBlack (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa. 0 Hispanic: All persons of Mexican, Puerto Rican, Cuban, Centre! or South American, or other Spanish culture or origin, regardless of race. 0 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, Incite, Japan, Korea, the Philippine Islands and Somoa. 0 American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain Guttural identification through tribal affiliation or community recognition. Physically Challenged: Yes 0 or Noff Employment Status: Employed Y Retired 0 Homemaker 0 Other 0 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 (Miaml - Dade County Code section 2- 11.1). o Prohibition from lobbying before boardlcornmittee 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. '1 ereby alt t to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, rti e VII — 0 the Code "Standards of Conduct for City Officers, Employees and Agency Members." 2/1/201 Jay Reinberg Ap. icant .not r Date Name of Applicant (PLEASE PRINT) Plea atta. copy • ' r resume to this application nt NOTE: Appil.. lons•will real • n file for period f o ( 1) calendar year.. Re:ewed in the City Clerks Office by • .1 �� / oat /7/20 0 (1 Control No. 1 Date: /12 // / Name of Deputy Jerk ` i �'� I i �� I �� I ! � Ii Jay E. Reinberg, MD 3105 Sheridan Avenue Miami Beach, Florida 33140 305- 469 -0145 ReinbergMD@yahoo.com Professional Work History Internal Medicine Physician 2003 - Present South Florida Multispecialty Association Miami Beach, Florida Internal Medicine Physician 2000 -2003 Internal Medicine Associates Miami Beach, Florida Attending Physician 1997 -2000 Mt. Sinai Medical Center Miami Beach, Florida Education and Medical Training Residency Internal Medicine 07/1994 - 07/1997 Mt. Sinai Medical Center Miami Beach, Florida Internship General Surgery 07/1992- 07/1993 Jackson Memorial Hospital Miami, Florida Doctor of Medicine 08/1988- 05/1992 University of Miami School of Medicine Miami, Florida Bachelor of Arts- Economics 08/1983- 05/1987 Emory University Atlanta, Georgia Licensure and Certifications Medical License, State of Florida ME 65783 Board Certified, American Board of Internal Medicine 1997, recertification 2007 Professional Memberships American College of Physicians 1998 - Present Honors Alpha Omega Alpha Doctor- Patient Relationship Award 1992 I I I I I i i I IC I I I � I I I I I I.