Joy V. W. Malakoff Application and Resume i
MIAMI CI T Y OF 1��11AN1i BEACH
BOARD AND CONIN11TTEE APPLICATION FORM
M A o Ec O y V, V.
Last Name First Name Middle Initial
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H me address City State Zip Ude
Home Telephone Work Telephone Cellular Telephone ' Email ess
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Business Name `
Business Address 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
for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months: Yes FQ or No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six months: Yes Z]or No
• Are you a registered voter in Miami Beach: Yes KIJ or No ID
• I am now a resident of: North Beach U South Beach U-Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
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• Are you present) a registered lobbyist with the City of Miami Beach?Yes or No &)v Y-k'
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that yrs
only three 3 choices will be observed by the City Clerk's Office. Regular Boards of City)
❑Affordable Housing Advisory Committee ❑ Fine Arts Board 0 Normandy Shores Local Government
Neighborhood Improvement
0 Art in Public Places Committee 0 Gay, Lesbian, Bisexual and Transgender 0 Parks and Recreation Facilities Board
Enhancement Committee GLBT
0 Beautification Committee 0 Golf Advisory Committee 0 Personnel Board
Board of Adjustment* * ❑ Health Advisory Committee J_i Planning Board**
0 Budget Advisory Committee 0 Health Facilities Authority Board 0 Police Citizens Relations Committee
0 Capital Improvements Projects 0 Hispanic Affairs Committee ❑ Production Industry Council
Oversight Committee .
❑Committee on the Homeless 0 Historic Preservation Board 0 Safety Committee
0 Committee for Quality Education in MB ❑ Housing Authority ❑Single Family Residential Review Panel
❑Community Development Advisory 0 Loan Review Committee ❑Sustainability Committee
0 Community Relations Board ❑ Marine Authority 0 Tennis Advisory Committee
0 Convention Center Advisory Board 0 Miami Beach Commission for Women 0 Transportation and Parking Committee
0 Debarment Committee ❑ Miami Beach Cultural Arts Council 0 Visitor and Convention Authority
❑ Design Review Board** ❑ Miami Beach Human Rights Committee ❑Youth Center Advisory Board
❑ Disability Access Committee 0 Miami Beach Sister Cities Program 0 Waterfront Protection Committee
* Board Required to File State Disclosure Form
If you seek appointment to a professional seat(e.g., lawyer, architect)on the Board of Adjustment, Design Review Board,
Historic Preservation Board, or Planning Board,attach a copy of your currently-effectively license,and furnish the
following information:
Type of Professional License License Nur"k J0 Q
License Issuance Date ,and License Expiraticts)l 11 1
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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 LJ No ED Years of Service:
2. Present participation in Youth Center activities by your children Yes U No U. 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:
*Have you ever been convicted of a felony:Yes or No Ca If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach codes:Yes Z9 or No . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money:Yes U or No,4 If yes, explain in detail
•Are you curr ntly serving on any City Boards or Committees:Yes .or No If yes;which board?
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•What organizations in th City of Miami Beach do you currently hold membership in?
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Name / 1 Title
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Name Title
• List all properties owned or have an interest in,which are located within the City of Miami Beach:
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• I am now employed by the City of Miami Beach:Yes or No .Which department?
• Pursuant to City Code Section 2-25(b): Do you have a parent I.J, 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.
Ethnic Origin: Check one only 1)
Gender: Male ED Female
White (Not of Hispanic Origin):All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
African-American/Black (Not of Hispanic Origin):All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican,Cuban,Central or South American,or other Spanish culture or origin,regardless of race.
Ea Asian or Pacific Islander:All persons having origins in any of the original peoples of the Far East,Southeast Asia,the Indian Subcontinent,or
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 throw h tribal affiliation or community recognition.
Physically Challenged: Yes or No lI
Employment Status: Employed Retired Homemaker ED Other
Please remember to attach a current resume and a copy of any applicable
professional license.
Attach additional sheets, if necessary, to provide required information.
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NOTE: IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO,THE FOLLOWING:
• Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• 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).
• Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
• 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 ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION, AND I 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."
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li is Signature Date Name of Ap licant(PLEASE PRINT)
Received in the City Clerk's Office by
ame of Deputy Clerk Control No. ate
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/\A I M BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
vvww.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-Dade
County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name: Toy
i understand that no later than July 1, of each year all members of Boards and Committees of the City of
Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County
Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or primary
responsibility is to recommend legislation or give advice to the City Commission, must file, even though you
may have been recently appointed.
You must file one of the following with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami
Beach, Florida, by July 1 each year.
1. A "Source of Income Statement" (attached); or
2. A "Financial Statement" (attached); or
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami-Dade County Code Chapter 1, General Provision, Section 1-5,
may subject the person or firm to a fine not to exceed $500.00 or by imprisonment in the county'jail for
a period not to exceed sixty days, or both.
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