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Martha Baker Application Package (2)Baker Martha Last Name First Name Middle Initial 1685 Cleveland Road Miami Beach Home Address City Florida 33141 State Zip Code 305-620-6555 HomeWork martha@seiu1991.org Email Address 305-510-7542 Cellular Miami Business Address 1601 NW 8th Avenue City Florida State 33136 Zip Code Occupation:Business Name: 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. (Regular Boards of City) Choice 1: Choice 2: Choice 3: Health Advisory Committee BOARD AND COMMITTEE APPLICATION FORM Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below questions: Have you ever resided in one of the City's Historic Districts for at least one year?Yes No Address in City Historic District submitted. Professional License License Number Issuance Date Expire Date Registered Nurse RN 1508072 8/1/2018 7/31/2020 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. 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: YesResident of the City for a minimum of six (6) months: Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:No AFFILIATION WITH THE CITY OF MIAMI BEACH a. ● I am resident of:North Beach Or b. "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. 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):No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 4/7th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements of section 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 filled with the Office of the City Clerk prior to being sworn in as a member. Or No● Have you ever been convicted of a felony:If yes, please explain in detail: ● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail: ● Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail: ● Are you currently serving on any City Boards or Committees:Yes If yes, which board? Health Advisory Committee ● Are you presently a registered lobbyist with the City of Miami Beach?No ● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: Leadership skills in the Healthcare field. Vast experience in the healthcare related matters. 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 board/committee you have served on for period of one year after leaving office (Miami Beach 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 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 equality to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143. Florida Statutes. ● In what organization(s) in the City of Miami Beach do you currently hold membership in? No Organization Information Submitted. ● List the address of all properties owned or in which you have an interest within the City of Miami Beach: Property 1685 Cleveland Road, Miami Beach, Florida 33141 If so, which department and title?No● Are you now employed by the City of Miami Beach: ● 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?No If "Yes", identify person(s) and department(s): No relative's information submitted. BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-Dade County Financial Disclosure Code Section 2-11.1(i)(2) 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 filled 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. _____________________________ 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 Board/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. DIVERSITY STATISTICS REPORT 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. WhiteRace/Ethnic Categories What is your race? No details providedOther Description: Gender:Female Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No Physically Challenged:No 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.” I Martha Baker agreed to the following terms on 12/20/2021 8:47:56 AM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES YES YES YES I have answered all questions fully. I have uploaded a current resume, photograph, and a copy of any applicable professional license. I have completed and attached the Board & Committee Financial Acknowledgment Statement. I have completed and attached the Diversity Statistics Report. 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. Martha Baker, RN 1685 Cleveland Road Miami Beach, FL 33141 305-510-7542 martha@seiu1991.org Service Employees International Union (SEIU) • SEIU Local 1991, 2008 – Present, Became President and Executive Director Jackson Health System, Miami, FL 1992 - 2019, Nurse Manager, Trauma Intensive Care Unit 1987 - 1992, Nurse Liaison, Surgical Intensive Care Unit 1984 - 1987, Staff RN, Surgical Intensive Care Unit Ohio State University Hospital Columbus, Ohio 1979 – 1984, Staff RN, Surgical Intensive Care Unit Professional Associations: • Serving as SEIU Local 1991 President Public, political, and contract advocate for membership of 5,500 healthcare employees. Cofounder of Labor Management Partnership at Jackson Health System to ensure quality outcomes for our patients, and financial sustainability for our Public Health Syste m. • Serving as SEIU Florida State Council Interim President • Serving as SEIU National Nurse Alliance Chair Public and political advocate for Nurse professional issues. Represent over 80,000 nurses nationwide. • Member of the Jackson Health System Obligation Bond (G.O.B.) Citizen’s Advisory Board Appearances and Other Projects: • March 2019, Speaker at the Healthcare Quality National Collaborative in Chicago. • October 2004 “Current Concepts and Controversies in the Treatment of HIV” Online / Webcast Course Co-Developer • October 2004 Agency Safe Staffing Program Speaker on Safe Ratio Implementation. • January 9-10, 2004 Nova Southeastern University (NSU) hosted its third annual conference on health care access, entitled: "A Glimpse of the Future of Health Care in America 2004." interactive community forum comprised of a distinguished panel of experts. • December 13, 2003 as part of presidential campaign. Martha Baker, RN and president of the SEIU Local 1991, was in charge of introducing Democratic candidate Howard Dean. • October 2003 SEIU National Nurse Alliance Conference Co-Chair and Opening / Closing Speaker, Breakout Teacher on Staffing Crisis and Safe Staffing Ratios . Martha Baker, RN, BSN President of SEIU Healthcare Florida Local 1991 Martha Baker is President of SEIU Healthcare Florida Local 1991, which represents over 5,500 nurses, doctors and healthcare professionals at Jackson Health System. Ms. Baker, the founding Nurse Manager of the Trauma Intensive Care Unit at Jackson Memorial Hospital, one of the largest public hospitals in the nation, is also the chair of the national 80,000-member SEIU Nurse Alliance. She has been an advocate on a wide range of patient care issues at the local and national levels. She has been an advocate on a wide range of patient care issues at the local and national levels. From her unique perspective as an ICU nurse and labor movement activist, Ms. Baker has testified before Congress on numerous occasions of the challenges facing the nursing profession today, including setting safe nurse staffing levels, implementing safe lifting, banning the unsafe practice of mandatory overtime in hospitals, protecting health care workers from the dangers of air-borne and blood-borne infectious diseases, and other policy, safety, and regulatory matters. Ms. Baker has also testified before the U.S. Senate on the President’s controversial proposals to vaccinate health care workers against the possibility of smallpox. Since her graduation from Ohio State University’s School of Nursing in 1979, Ms. Baker has dedicated her life to effective patient advocacy and improving the quality of patient care in our nation’s hospitals. She currently resides in Miami Beach, Florida, where she is a prominent RN leader and nurse voice for union and non-union nurses in the state. SEIU Healthcare Florida Local 1991 is the largest public healthcare union in Florida and is affiliated with the Service Employees International Union, the largest and fastest-growing union in the country with more than two million members.