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Last Name First Name Middle Initial
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Home Address 7-
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Cellular Telephone Work Telephone
City State
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Home Telephone
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Zip Code
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Email ad@re, z1 cm
/a Business Name Occupation
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Business Address City State Zip Code
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.
Ad Hoc Anti-Bullying Task Force Health Advisory Committee Normandy Shores Local Government
Neighborhood Improvement District
Advisory Council
Affordable Housing Advisory Health Facilities Authority Board Parks and Recreational Facilities
Committee Board
Animal Welfare Committee Hispanic Affairs Committee Personnel Board
Art in Public Places Committee Historic Preservation Board * Plannina Board
Audit Committee Housinq Authority Police/Citizens Relations Committee
Board of Adjustment Human Rights Committee Production Industry Council
Budget Advisory Committee LGBTQ Advisory Committee Program for Public Information
Committee
Committee for Quality Education in Marine & Waterfront Protection Senior Affairs Committee
Miami Beach Authority
Committee on the Homeless Mayor's 41 st Street Committee Sustainability Committee
Convention Center Advisory Board Mayor's General Obligation Bond Transportation, Parking, and Bicycle-
Oversight Committee Pedestrian Facilities Committee
Cultural Arts Council Mayor's Panel on Ocean Drive Visitor and Convention Authority
Design Review Board Miami Beach Commission for Women Youth Commission
Disability Access Committee Next Generation Council
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3. Hts otd Bro1go &mu re
Professional License
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Type of Professional License License umber
Zn22o
State of Issuance
Cer/ /z
License Issuance Date
Kerr
License Expiration Date
Note: If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of your
currently effective corresponding professional license.
Page 1 of 6
F:ICLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
A F F ILI A T IO N W IT H T H E C IT Y O F MIAMI BEACH
Pursuant to City Code section 2-22(4) a, b, and c: Members of Agencies, Boards, and Committees shall be affiliated
with the City. This requirement shall be fulfilled in the following ways:
a. Resident of the City for a minimum of six months: Y [a r [hNo
• I am a resident of: South Beach IE Middle Beach O North Beach O
Or
b. Demonstrates an ownership interest (for a minimum of six months) in a business established in the City (for a minimum
of six months): Yes l or 2hNo
"Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more
of the outstanding capital stock) in a business.
"Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or
business association.
Or
c. Full-time employee of such a business (for a minimum of six months); and I am based in an office or other location of
the business that is physically located in Miami Beach (for a minimum of six months): Yes Ll or lkN
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by
a 417th vote of the Mayor and City Commission.
NO TE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation
requirements of sections 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulating that they
have met either (or both) of said affiliation requirements. The original affidavit shall be filed with the Office of the City Clerk
prior to being sworn in as a member.
• I am applying for an appointment because I have special abilities, knowledge, and experience. Please list below:
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L(Ki? Et let ddL±6 ¿ y7 dLluL A Ly rut<< 4LT¥ HALL.
Page 2 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated: June 2020
• Ar e yo u a regi s ter e d active lob b yi st wi th th e Ci ty of Mi am i B e a ch ? Yes llor No L
• Have you ever been convicted of a felony? Yes ll or No l{ lyes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes ll or No ll 1ryes, please explain in detail:
• Do you currently owe the City of Miami Beach money? Yes llor No [} ¡yes, please explain in detail:
• Are you currently serving on any City Board or Committee? Yes l/or No l 1t yes, which Board/Committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
'0
Name Position
Jo
Name Position
• List the address of all properties ownea or in which you have an interest within the City of Miami Beach:
'is Lle <A emL nlt so el24si dL3
d a r9A
• Are you now employed by the City of Miami Beach? Yes l±or No [ tr so, which department and title?
• Pursuant to City Code Section 2-25 />): Do you have a parent O, spouse O, child O brother O or sister O
who is employed by the City of Miami Beach? Yes lo: w [
If "Yes," identify person(s) and department(s): /[//t
* Note: If applying for the At-Large p:·sition of the Historic Preservation Board, please answer the below questions:
• Have you ever resided in one of U e City's Historic Districts for at least one year? Yes O or No O
If you answered "Yes," please indi•:ate:
From: To
Address Dates
From: To
Address Dates
Page 3 of 6
FICLERISALLIREGBOARD AND COMMITTEE APPLIC ONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
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 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 88 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.
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."
ture Name of Applicant (PLEASE PRINT)
Board and Committee Application Checklist: Please ensure you have provided all information before applying or
reapplying to any Board and Committee
[ Ihave answered all questions fully.
O I have attached additional sheets, if necessary, to provide required information.
[Z] 1have attached a current resume, photograph, and a copy of any applicable professional license.
Œf I have completed and attached the Board & Committee Financial Acknowledgement Statement.
IRf I have completed and attached the Diversity Statistics Report.
O Submit complete application package.
Via Email: BC@miamibeachfl.gov
Via U.S. Mail or in Person:
City of Miami Beach
Office of the City Clerk / Board and Committee Section
1700 Convention Center Drive, 18 Floor
Miami Beach, FL 33139
If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or telephone:
305.673.7411.
Note: Florida Statutes §119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as public
records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish
your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address
for your mailing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a
photograph.
Page 4 of 6
F:\C LE R\$A LL\RE G \BO A R D A N D CO M M ITT E E APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl. goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
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)
bAL 1z lt=
Last Name First Name Middle Initial
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.
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;" or
2. A "Statement of Financial Interests (Form 1)1;" or
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 $500, 60 days in jail, or both.
«_. #. 22a - V Signature r
ye[zuy7o
Date' 7
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Bard/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:ICLER1$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
MI AM AL BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 331 39
www._miamibeachhl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
hi=rrez /IG2
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
ate
? remale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
Ll Caucasian/white
L_! Native American/American Indian
O Other - Print Race: _
f1 refer not to answer.
Do you consider yourself to be S,anish, Hispan ic, or Latino/a?
2Sves
Jo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
lves
51o
L_Ji prefer not to answer this quesion.
Page 6 of 6
FICL ERISALLIREGBOARD AND COMMIT TE E APPLICATIONS FINAL DRAFTS\BOARD AND COM MITTE E APPLICATION REG FINAL.docx
Updated: June 2020
A M E N D M E N T
MAGUI BENITEZ'S RESUME
Present address: 757 West Avenue apt. #412. Miami Beach. Fl. 33139
E-mail; Mbenitez045@gmail.com
Phone: 786.368.4449
PROFESSIONAL EXPERIENCE
*"Unidad", Miami Beach Hispanic Community Center, Archdiocese of Miami
Part Time was terminated on October/2008.
Royal Caribbean International" continous working since Jan.1999 to
November,2012. when I retired.
Magu i Benitez
7705 Abbott Ave #206 • Miami Beach, FL 33141 • (305) 868-8532 / (786) 368.4449 (cell)
PROFESSIONAL OBJECTIVE
To work in a professional atmosphere where I can use my training and experience and
attain a high level of job satisfaction.
PROFESSIONAL EXPERIENCE
July 21" to Present.
Jan. 1999 to April, 2008
Nov. 2000 to 2004
Oct. 1997 to Aug. 1998
Jun. 1997 to Oct. 1997
Jan. 1997 to Jun. 1997
Jun. 1993 to Dec. 1996
"Unidad", Miami Beach Hispanic Community Center.
Archdiocese of Miami.-Part Time
Office Clerck, computer data entry etc.
Royal Caribbean International
Pre and Post Guest Operation - Part time
Cruise Line Costumer Services, complete check-in process.
Miami Heart Institute
Miami Beach, FL (305)672-1111
Cardiovascular Department - Per Diem
Covering EECP clinic, Heart station and Cardiac rehab.
EECP Treatment/therapy, SUB Coordinator, monitor EKG.
Register Il
Patient registration, insurance verification etc.
Office Manager of Senior Health Center
Coordination of all activities in the Center; All clerical
duties, billing, charges, etc.
Volunteer Work
Responsible for the front desk and ambulatory surgery.
OCHO"RAY INC.
Miami, FL (305)263-97
Page tw o
Feb. 1989 to Dec. 1991
Jun. 1987 to Feb. 1989
Feb. 1981 to Jul. 1986
ED U C A T IO N
Jan. 1992 to Jan. 1993
Jan. 1959 to Jan. 1962
G ra phic C om posing
M iam i, FL
Junior A ccountant - All accounting duties
Laboratory M edicine
Mi a mi, FL (305)267-1603
Bookk eeper
Responsible for AIR, P/R, bank reconciliation's, etc ..
Dade Steel Sales
Mi am i, FI (305)591-7558
O ffi ce M anager
C ardiovascular, Cardiographie and Phlebotom y Tec hnologist
National School of Technology
Hialeah Campus
Elem entary Teacher
School of Elementary Teacher
Cuba
SUMMAR Y O F Q U AL IFI C A TI ON
Registered Cardiovascular Technologist (non-invasive)
Certified Cardiographie Technologist (CCT)
Certified Phlebotomy Technician #6405089210 95
EECP Clinical Training Certificate
PER SO N AL
Organized, dependable and able to deal effectively with people at all levels.
Bi-lingual; Fluent written and spoken Spanish.
Excellent health; Enjoys traveling after children graduated from college.
RE FE RE N C ES A V AIL A BLE UP O N RE Q U EST