James F. Silvers Board application r
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MIA.Ml E BOARD AND COMMIT-1 EE APPLICATION FC3PM
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Last Na a F'rst Name J Middle Ini' I
Home Address City Sta Zip Code
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Home Telephon Work elephone Cellular Telep ne Email address
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Busin ssNam � � �� , l_ G� Occupation
Business Address City State Zip Code
Professional License(describe): Expires:
Please attach'a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a & 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 ha a been a resident of the City for a minimum of six
months; or b. An individual shall demonstrate ownershipAnterest for a minim 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 or No
• Demonstrates ownership/interest in a business in M' mi Beach for a minimum of six months: Yes ED or No ED
• Are you a registered voter in Miami Beach: Yes or No
• I am now a resident of: North Beach ED South Beach L�4rmiddle Beach ZI
• I am applyirig for an p ointm nt bec use I h ve s ecial abili ' knowledge and ex eer' nce. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach?Yes ED 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 3 choices will be observed by the City Clerk's Office.
0 Affordable Housing Advisory Committee ❑Fine Arts Board 0 Normandy Shores Local Government
Neighborhood Improvement
❑Art in Public Places Committee 0 Disability Access Committee ❑Parks and Recreation Facilities Board
0 Beautification Committee 0 Gay, Lesbian, Bisexual and Transgender 0 Personnel Board
Enhancement Committee GLB
0 Bicycle-Pedestrian Advisory Con3R#qtee 101 off Advisory Committee 0 Planning Board
oard of Adjustment* 0 Health Advisory Committee 0 Police Citizens Relations Committee
0 Budget Advisory Committee 0 Health Facilities Authority Board 0 Production Industry Council
0 Capital Improvements Projects 0 Hispanic Affairs Committee ❑Safety.Committee
Oversight Committee
0 Committee on the Homeless 0 Historic Preservation Board ❑Single Family Residential Review Panel
0 Committee for Quality Education in MB 0 Housing Authority 0 Sustainability Committee
0 Community Development Advisory 0 Loan Review Committee ❑Tennis Advisory Committee
0 Community Relations Board ❑Marine Authority 0 Transportation and Parking Committee
❑Convention Center Advisory Board 0 Miami Beach Commission for Women 0 Visitor and Convention Authority
0 Debarment Committee 0 Miami Beach Cultural Arts Council 0 Youth Center Advisory Board °O
0 Design Review Board* 0 Miami Beach Human Rights Committee 0 Waterfront Protection Committee
0 Miami Beach Sister Cities Program
OZ •OI V llijocloz
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°O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board:Yes No LJ Dates of Service:
2. Present participation in Youth Center activities by your children:Yes ED No
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: A ne: Program:
• Have you ever been convicted of a felony?Yes Lj or No LA If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes L]or N If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes Z)or No If yes, explain in detail:
•Are you currently serving on any City Board or Committee?Yes 1:3 or No If yes,which board/committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List all properties owned r in which you ;n int rest wi jij�e�ity of Miami Beach:
T11
•Are you now employed by the City of Miami Beach?Yes ID or No 1�j
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ID, spouse , child brother or sister who is
employed by the City of Miami Beach?Check all that apply.
If"Yes,"identify person(s) and department(s): U
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for
appointment. It is bei g asked to comply with City diversity reporting requirements.
Gender: Male Female
Race/Ethnic Categories
What is your race?
ican-American/Black
L.IJ Caucasian/White
ID Asian or Pacific Islander
Native-American/American Indian
Other—Print Race:
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Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
No
Yes
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:
• 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 the 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).
• Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities.
• Voting conflict—Form 8B is for use by any person serving at the county, city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
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 MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFICERS, EMP E AGENCY MEMBERS AND ALL OTH R APPLICABLE OUNTY AND/OR STATE LAWS AND
STATUTES ACCO IN Y '
Applicant's Signature D to Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by
Name of Deputy Clerk Con of No. ate
PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A
COPY OF ANY APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
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