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Rachel Weissman Application PackageAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Last Name First Name ddle I itial lo42- W 41 oour-t- M b.. 33140 Home Address City State Zip Code 3 •32t qua) au tjo ftL,( om Home Telephone Work Telephone Cellular Telephone Email address Business Name Business Address Professional License (describe): Occupation City Please attach a copy of currently effective professional license. State Zip Code 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 —r No • Demonstrates ownership/interest in a business in Mml wi Beach for a minimum of six months: Yes �No EZI • Are you a registered voter in Miami Beach: Yes LOor No E ,�/ . I am now a resident of: North Beach 0 South Beach QMiddle Beach Lr • 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 1z1 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 Offi _ _ of the Q0tX Clark, Affordable Housing Advisory Committee Health Advisory Committee Parks and Recreation Facilities Board Art in Public Places Committee Health FacilitiesAuthority Board Personnel Board Audit Committee Hispanic Affairs Committee Planning Board' Board of Adjustment Historic Preservation Board Vr Police Citizens Relations Committee BudgetAdvisory Committee Housing Authority Production I ndus�try Council Committee on the Homeless Human Rights Committee Sister Cities Program Committee for Quality Education inMB LGBT Advisory Committee Sustainability Committee Convention CenterAdvisory Board Marine & Waterfront Protection Authority Transportation, Parking, & Bicycle -Pedestrian Facilities Committee Cultural Arts Council I Miami Beach Commission forWomen Vsitorand Convention Authority Design Review Board IT Normandy Shores Local Government Neighborhood Improvement Youth Commission Disability Access Committee Ad Hoc An i -Bullying Task Force Miami Beach Hall of Fame Selection Committee Mayor's 41 Street Committee I Ad Hoc Small Business Task Force Senior Affairs Committee 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 License Issuance Date License Expiration Date Page 1 of 4 CAUserslCLERQueRU)esktop1BC APPLICATIONAm a. 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 0 No Q". If yes, please list below the names of your children, their ages and the programs in which they participate: Child's name: Child's name: • Have you ever been convicted of a felony? Yes Age: Program: Age: Program: or No If yes, please explain in detail: • Do you currently have a violations) 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 Ej or No Ii If yes, explain in detail: • Are you currently serving on any City Board or Committee? Yes EJ or No QX 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 by the City of Miami Beach? Yes 1:3 or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you havtA parent U spouse Q, child 0 brother or sister 0 who is employed by the City of Miami Beach? Yes ❑or No 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 " Female JVj Race/Ethnic Categories What is your race? 0 can-American/Black 'd Caucasian/White ID Asian or Pacific Islander 0 Native-American/American Indian CAUserslCLE RCueR0esktop1BC ID Other — Print Race: Do you consider yourself to be Spanish, Hispanic or Latinota? Mark the "No" box if not Spanish, Hispanic, Latino/a. Io No 4:k Yes Do you consider yourself Physically Disabled? IZNo ID 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 maybe 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 ACCORDINGLY." Received in the Office of the City Clerk by: Name of Deputy Clerk Control No. Date ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. Page 3 of 4 CAUsers\CLERQueR\Desktop\BC APPLICATION.docx MIAMI BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK CityClerk@miamibeachfl.gov Telephone: 305.673.7411 Fax: 305.673.7254 Acknowledgement of finestsuspension 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: JVW ky" "A S WXWy 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. Signature Updated Thursday, December 22, 2016 Date Rachel Weissman 1042 West 47 Court Miami Beach, FL 33140 305-321-4000 rkoltunoaol.com Dedicated individual who has been volunteering in the community for the last 14 years. Possesses an exceptional ability to establish a cooperative and professional relationship with parents, staff and administration. Is an effective written and oral communicator who will prioritize success and achievements. Work History Parent Teacher Student Association Volunteer, 8/2015- present Nautilus Middle School -4301 North Michigan Avenue, Miami Beach, FL 33140 Hospitality Co -Chair Treasurer Parent Teacher Association Volunteer, 8/2009 to present North Beach Elementary- 4100 Prairie Avenue, Miami Beach, FL 33140 Room Parent Coordinator Treasurer Vice President of Fundraising President Vice President of Enrichments 4th Grade Fundraising Chair 5th Grade Fundraising Chair Board of Trustees, 8/2009-8/2016 Temple Beth Sholom- 4144 Case Avenue, Miami Beach, FL 33140 Co- Chair Education Committee Co- Chair Mitzvah Day Parent Teacher Organization Volunteer, 8/2006-8/2010 Temple Beth Sholom- 4144 Case Avenue, Miami Beach, FL 33140 Room Parent President Treasurer Education Bachelor of Arts- Fashiorl Merchandising 1998 Colorado State University, Fort Collins, Colorado A Ilk