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Faye Goldin Application PackageI APINAI B EAC H G_�o a f Last Name Home Address 1,7 Home Telephone Work Telephone Business Name Business Address Professional License (describe L4OArdC7 AND CCifJIIV1ITTEE APPLICATION FORM I TT First JName t �. City 6 5--3,3" Cellular Telephone Occupation City Please attach a copy of currently effective professional license. Miatlle Initial 3 1 i Zip Code Email address T State Zip Code )(p i res: 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 Tati, No • Demonstrates ownership/interest in a business in M' mi Beach for a minimum of six months: Yes W No • Are you a registered voter in Miami Beach: Yes �Zor No LJ • I am now a resident of: North Beach E3South 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 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 Office of the City Clerk, Affordable Housing Advisory Committee Health Advisory Committee Parks and Recreation Facilities Board °Q ArtinPublicPlacesCommittee Health Facilities Authority Board Personnel Board AuditCommittee Hispanic Affairs Committee PlanningBoard BoardofAdjustment' Historic Preservation Board Police Citizens Relations Committee Budget Advisory Committee HousingAuthority Production Industry Council CommitteeontheHomeless Human Rights Committee SisterCitiesProgram CommitteeforQualityEducationinMB LGBT Advisory Committee Sustainability Committee Convention CenterAdvisory Board Marine & Waterfront Protection Authority Transportation, Parking, & Bicycle -Pedestrian Facilities Committee CulturalArtsCouncil Miami Beach Commission for Women Visitor and Convention Authority Design ReviewBoard Normandy Shores Local Government Youth Commission Neighborhood Improvement Disability Access Committee I Ad Hoc Anti -Bullying Task Force Ad Hoc Small Business Task Force 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,E)"rat[gp Dote F i4 Page 1 of 4 81 s i t hed " Liu . i.V C:\Users\CLERQueR\Desktop\BC APPLICATION.dou 4 Other — Print Race: 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: 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 STA1UTES ACCORDINGLY." re Applicant (PLEASE PRINT) 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, INFORMATION. IF NECESSARY, Page 3 of 4 C:\Users\CLERQueR\Desktop\BC APPLICATION.dou TO PROVIDE REQUIRED 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 No ID 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 or No 4U, If yes, please explain in detail: Pull • Do you currently have a violation(s) of City of Miami Beach Code? Yes or No6&J If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes 4—_l or No If yes, explain in detail: • Are you any yty tsoara or • In what organization(s) in the City of Miami Beach do you currently hold membership? FTiiLa Position Name Position • List all opertie ned or in which you have a Interest within th Cit of la i ea h: • Are you now employed by the City of Miami Beach? Yes or No Ex Which department and title? which board/committee? • Pursuant to City Code Section 2-25 (b): Do you have a parent 4, spouse , child Z1 brother U or sister ID who is employed by the City of Miami Beach? Yes or No To 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 I I Female Race/Ethnic Categories What is your race? African-American/Black CaucasianNVhite i Asian or Pacific Islander E Native-American/American Indian Page 2 of 4 CAUsers\CLERQueRlDesktopl8C APPLICATIONAnx Name: Faye Goldin Address: 5415 Collins Avenue, Apt.: PHA Miami Beach, Florida 33140 Date of Birth: April 1, 1941 Place of Birth: Brooklyn, New York Marital Status: Married Education: 1954 -1958: Yeshiva of Flatbush High School Brooklyn, New York 1958 -1962: Bachelor of Art, Brooklyn College Brooklyn, New York Work Experience: 1962 —1968: Teacher, New York Public Schools Brooklyn, New York 1976 —1986: Sales Associate, Neiman Marcus Bal Harbour, Florida 1986 — 2010: Personal Shopper, Neiman Marcus Bal Harbour, Florida Organizations: 1989 — 2010: Young Presidents Club, Mount Sinai Medical Center Miami Beach, Florida 1991— 2010: Founders Club, Mount Sinai Medical Center Miami Beach, Florida 1992 — 2010: Founders Club, Miami Jewish Health Systems Miami Beach, Florida CMB Committees: 1990-1998: Fine Arts Board 1999 — 2005: Beautification Committee 2005 — 2010: Police Citizens Relations Committee 2011— 2013: MB Sister Cities Committee 2016 — Present: MB Commission for Women Name: Faye Goldin Address: 5415 Collins Avenue, Apt.: PHA Miami Beach, Florida 33140 Date of Birth: April 1, 1941 Place of Birth: Brooklyn, New York Marital Status: Married Education: 1954 - 1958: Yeshiva of Flatbush High School Brooklyn, New York 1958 -1962: Bachelor of Art, Brooklyn College Brooklyn, New York Work Experience: 1962 —1968: Teacher, New York Public Schools Brooklyn, New York 1976 —1986: Sales Associate, Neiman Marcus Bal Harbour, Florida 1986 — 2010: Personal Shopper, Neiman Marcus Bal Harbour, Florida Organizations: 1989 — 2010: Young Presidents Club, Mount Sinai Medical Center Miami Beach, Florida 1991— 2010: Founders Club, Mount Sinai Medical Center Miami Beach, Florida 1992 — 2010: Founders Club, Miami Jewish Health Systems Miami Beach, Florida CMB Committees: 1990 —1998: Fine Arts Board 1999 — 2005: Beautification Committee 2005 — 2010: Police Citizens Relations Committee 2011— 2013: MB Sister Cities Committee 2016 — Present: MB Commission for Women