The URL can be used to link to this page

Brooke Owens Application PackagePage 1 of 4 C:\Users\CLERQueR\Desktop\BC APPLICATION.docx BOARD AND COMMITTEE APPLICATION FORM Owens Brooke Last Name First Name Middle Initial 2008 Alton Road, Miami Beach, Fl 33140 Home Address City 6106132598 State Zip Code brookeaowens@gmail.c om Home Telephone VCA Alton Road l Work Telephone Animal Hospital Cellular Telephone Veterinarian Business Name 1828 Alton Road Miami Beach, FL 33140 Occupation Business Address City State Zip Code Professional License (describe): VM11728 Expires: 5/31/20 Please attach a copy of currently effective professional license. 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 ∞ Art in Public Places Committee Health Facilities Authority Board Personnel Board Audit Committee Hispanic Affairs Committee Planning Board* Board of Adjustment * Historic Preservation Board Police Citizens Relations Committee Budget Advisory Committee Housing Authority Production Industry Council Committee on the Homeless Human Rights Committee Sister Cities Program Committee for Quality Education in MB LGBT Advisory Committee Sustainability Committee 2 Convention Center Advisory Board Marine & Waterfront Protection Authority Transportation, Parking, & Bicycle-Pedestrian Facilities Committee Cultural Arts Council Miami Beach Commission for Women Visitor and Convention Authority Design Review Board Normandy Shores Local Government Neighborhood Improvement Youth Commission Disability Access Committee Ad Hoc Anti-Bullying Task Force Miami Beach Hall of Fame Selection Committee Next Gen Council Animal Welfare Committee 1 Mayor’s 41st Street Committee 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 xx 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 x or No Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes x or No Are you a registered voter in Miami Beach: Yes x or No I am now a resident of: North Beach South Beach Middle Beach x 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 Page 2 of 4 C:\Users\CLERQueR\Desktop\BC APPLICATION.docx NO ● Do you currently have a violation(s) of City of Miami Beach Code? Yes or Nox If yes, please explain in detail: NO ● Do you currently owe the City of Miami Beach any money? Yes or No x If yes, explain in detail: NO ● Are you currently serving on any City Board or Committee? Yes or No. x 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: 2008 Alton Road, Miami Beach ● Are you now employed by the City of Miami Beach? Yes or No x Which department and title? ● Pursuant to City Code Section 2-25 (b): Do you have a parent , spouse , child brother or sister who is employed by the City of Miami Beach? Yes or No If “Yes,” identify person(s) and department(s): NO 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 Race/Ethnic Categories What is your race? African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian x ∞ 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 If yes, please list below the names of your children, their ages and the programs in which they participate: Child’s name: Program: Child’s name: Program: ●Have you ever been convicted of a felony? Yes or No If yes, please explain in detail: Page 3 of 4 C:\Users\CLERQueR\Desktop\BC APPLICATION.docx 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.” Dr. Brooke Owens 10/31/18 Brooke Owens Applicant’s Signature Date Name of 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, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. 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 may be obtained from the City Clerk. Brooke Owens, VMD, CVA 2002 Alton Road, Miami Beach, Florida, 33140 (610) 613-2598 brookeaowens@gmail.com EMPLOYMENT EXPERIENCE −Associate Veterinarian, VCA Alton Road Animal Hospital , Miami Beach, Florida, September 2014-Present −Emergency and Critical Care Veterinarian, Miami Veterinary Specialist, Miami, Florida, August 2011 – 2013 −Rotating Small Animal Internship, The Animal Medical Center, New York, NY, June 2010 – July 2011 −Wilmington Animal Hospital, Wilmington, DE Veterinary Technician, Summer 2008 −University of Pennsylvania Swine Unit, New Bolton Center Sow Welfare Research Project, Summer 2007 −Caring Hands Animal Hospital, Arlington, VA Veterinary Technician, January 2006 – August 2006 −Heart of Chelsea Animal Hospital, New York, NY Receptionist, Veterinary Assistant, October 2003 – August 2005 EDUCATION −Certified Veterinary Acupuncturist, Colorado State University Medical Acupuncture for Veterinarians Program, Fort Collins, CO, May 2009 −VMD, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, May 2010 −Pre-veterinary Post-baccalaureate, Columbia University, New York, NY, May 2005 −Bachelor of Arts, History, Princeton University, Princeton, NJ, June 2002 ACADEMIC HONORS −University of Pennsylvania, School of Veterinary Medicine Dean’s List 2006-2010 −Princeton University The Princeton University Environmental Thesis Prize, 2002 ADDITIONAL VETERINARY EXPERIENCE −ASPCA Shelter Medicine Externship, New York, NY, January 2009 −Center for Comparative and Integrative Pain Medicine Externship, Colorado State University, Fort Collins, CO, February 2009 −PVMA Native American Project, New Mexico, October, 2009 Volunteer, Spay/Neuter Clinic −University of Pennsylvania Foster Kitten Program, Philadelphia, PA, 2007-2010 Coordinator −Animal Welfare Association, Voorhees, NJ, 2007-2009 Volunteer PERSONAL ACCOMPLISHMENTS −Princeton University Women’s Lacrosse Team, 1999-2002 NCAA Division I National Champions, 2002 Ivy League Champions, 2001 and 2002 Participant, 2001 NCAA Division I Final Four, 2000 NCAA Division I Finals, All-American Selection, 2001 and 2002