Yael A. Sade Application Package MIA I4`
EAc:/� 1 BOARD AND CO AITTEE APPLICATION FORM
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Last Name First Name Middle Initial
(c f 9 /∎/&/s pL /J/41-\ A:V Nr 1.4/W/ ,f �C�/ . -'3. l3 0
Home Address City State Zip Code
7 2 4Z-662- �� 1_. ,J -0 - .,A11.-.CA,
Home Telephone Work Telephone Cellular Telephone Email address
/:- /7 -L---/.--- /2i/c L L_ /v 7A ,,,aL &,\/--M. /•46R06/•1or LJf SL
Business Name Occupation
I / 7 40 e3iRT> !C '7 Ivii, ,L - 3,/75
Business Address r City State Zip Code
Professional License(describe): fL_ 12 /, "7-- 1,217 f li Expires: 4/2&/vS
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 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 or No DJ
• Demonstrates ownership/interest in a business in M' mi Beach for a minimum of six months: Yes or No[2(
•Are you a registered voter in Miami Beach: Yes►,"N or No
• I am now a resident of: North Beach 11 South Beach Middle Beach Li
• 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 Li 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.
❑Ad Hoc Committee Centennial Celebration ❑Health Advisory Committee
0 Parks and Recreation Facilities Board °O
❑Affordable Housing Advisory Committee ❑Health Facilities Authority Board ❑Personnel Board
❑Art in Public Places Committee ❑Hispanic Affairs Committee ❑Planning Board
❑Board of Adjustment* * ❑Historic Preservation Board * ❑Police Citizens Relations Committee
❑Budget Advisory Committee ❑ ousing Authority ❑yoduction Industry-Council
❑Committee on the Homeless P'Marine&Waterfront Protection Authority ---I'Sustairiability Committee ``-3
❑Committee for Quality Education in MB ❑Miami Beach Commission for Women Et/Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Visitor and Convention Authority
❑Design Review Board** ❑Miami Beach Human Rights Committee
❑Disability Access Committee ❑Miami Beach Sister Cities Program
❑Gay,Lesbian,Bisexual and Transgender ❑Normandy Shores Local Government
Enhancement Committee(GLBT) Neighborhood Improvement
* Board members are required to file Form 1 —"Statement of Financial Interest"with the State.
*If you seek appointment to a professional seat(e.g., lawyer, architect, etc.) 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 Number c-: ,.,,
-
- y
A
License Issuance Date License Expiration Date --:- "' :,r—,
4:
i T
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°O Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with
the Scott Rakow Youth Center and/or the North Shore Parks Youth Center:
• Please describe your past service with the City's Youth Centers(include dates of service):
• Present participation in Youth Center activities by your children:Yes 41 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: Age: Program:
• Have you ever been convicted of a felony?Yes P or No liIf yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes L_1 or Noll If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes D or No 1 70l If yes, explain in detail:
•Are you currently serving on any City Board or Committee?Yes or No["tl 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 or in which you have an interest within the City of Miami Beach:
•Are you now employed b the City of Miami Beach?Yes l!or No 12(
Y by Y
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent 1, spouse [ ], child brother or sister La who is
employed by the City of Miami Beach?Check all that apply.
If"Yes,"identify person(s)and 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 City diversity reporting requirements.
Gender: Male La Female[77(
Race/Ethnic Categories
What is your race?
I African-American/Black
El Caucasian/White
I Asian or Pacific Islander
R.Native-American/American Indian
Other—Print Race: ■ffx'J
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1
Do you consider yourself to be Spanish,Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
I-- (No
D1 Yes
Do you consider yourself Physically Disabled?
INo
DI 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:
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 the 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).
o 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).
o 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.
o 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,EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES AC 7 NGLY."
14645 BSc e
fAppli•ant's'$'� re Date Name of Applicant(PLEASE PRINT)
r �
-ceived in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
PLEASE 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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M 1 AAA I E
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name:
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
Financial 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 they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A "Source of Income Statement"
2. A "Statement of Financial Interests (Form 1)"
3. A Copy of your latest Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
(Li / 5 /5
7atu Date
Updated: Monday,June 02,2014
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Yael Sade
1525 Pennsylvania Ave 786-264-2662
Miami Beach,Florida 33139 jaelanne @gmail.com
Education Associate's Degrees in Nursing(12/2013)and Emergency Medical Services(7/2012)
awarded by Miami Dade College,Medical Campus
Paramedic Certificate(4/2011)and Emergency Medical Technician Certificate(5/2009)
awarded by Miami Dade College,Medical Campus
High School Diploma,awarded by North Miami Beach Senior High School
Licensure And Nursing License(RN9378889)and Paramedic License(PMD522679)issued by the Florida
Certifications Department of Health
Trauma Nurse Core Course Certification issued by the Emergency Nursing Association
Healthcare Provider CPR,Pediatric Advanced Life Support,and Advanced Cardiac Life
Support certifications issued by the American Heart Association
Work History
June 2014 to Kendall Regional Medical Center 11750 Bird Road,Miami,Florida
present kendallmed.com
Registered Nurse,Emergency Room
Initial and ongoing assessment of acutely injured and ill adult patients;venipuncture;safe
and/or sterile collection
of bodily fluids and tissues for laboratory testing;operation of various heath monitors
including 3,4,and 12 lead EKG;safe administration of medications via oral and invasive
routes;personal health data collection,recording and analysis following stringent HIPPAA
practices;assisting emergency department physicians with procedures;caring and
advocating for multiple patients in a fast-paced environment;prioritizing patient care
according to acuity of illness or injury;providing emotional as well as physical support to
nurture patient physical and psychological well-being;maintaining a safe and clean
environment for patients and families with diverse backgrounds,languages,and cultural
needs during the stressful events of illness and injury.
11/2009 to present Fritz's Skate Bike and Surf 1620 Washington Avenue,Miami Beach,Florida
fritzsmiamibeach.com
Sales Associate,Bicycle Technician
Handled paperwork for repairs,maintenance,custom,rental and special orders;repaired
and maintained customer and rental fleet bicycles and skateboards;sales of bicycles,
skates,skateboards,accessories,electronics and clothing;maintained organization and
cleanliness of displays,storage,and sales area;assisted in yearly inventory;provided
excellent customer service to a multicultural,multilingual customer base of international
tourists and locals.
10/2012 to 7/2014 Ricky's NYC 536 Lincoln Road,Miami Beach,Florida
rickysnyc.com
Cashier
Answered phones and assisted callers;quickly and accurately ring out transactions and
make change;ensure opening and closing register amounts matched total cash sales;
maintained cleanliness and organization of store,backstock and displays;received and
restocked merchandise;assisted customers.
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the:taws and rules of the state of Florida a "� "
E iratioo Date APRIL 30 20"15 y• "-ri` ;1� ` -'2;, '••
YAEL ANfNE SAVE .
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DISPLAY IF REQUIRED BY LAW
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: - '':DEPARTMENT OF HEALTH
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DIVISION OF MEDI CAL'QUALITY ASSl1RANCE
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DATE: CERTIFICATION.NO . CONTROL NO:- „.:
. ' 02/19/2015 .: PMD 522679 - '`'14620'6 i - t
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The PARAMEDIC j �T
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the law s arid rules Of the state of Florida • - ,,
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Expiration Date DECEMBER;1,2016 �' -5 " Y` °'''�
YAEL ANNIE SAD_E v,:-' :Ij .t-.-3,:;:.,',;,-, ; - 1 ems; �7,s I
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' :Rick Scott . .. John H. Armstrong, MD :FA
GOVERNOR • STATE SURGEON;GENERAL
DISPLAY IF...REQUIRED•