Al Feola 12/31/2007 (2)
Note: If applying for Youth Advisory Board. please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes: . No ,j~ears of Se~:
2. Present participation in Youth Center activities by your children Yes No . If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Prograrn:
Child's name:
Age:
Program:
.Have you ever been convicted of a felony: Yes [J or No /If yes, please explain in detail:
· Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No ~ yes, please explain in detail:
· Do you currently owe the City of Miami Beach any money: Yes 0 or No rllf yes, explain in detail
· Are you currently serving on any City Boards or Committees: Yes 0 or No . If yes; which board?
· What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Title:
Name:
Title:
· List all properties owned or have an interest in, which are located within the City of Miami Beach:
?,sD OCCAA/ eJL. eP.ao t..u. ~I/l> 'b~ iJlt-.
· I am now employed by the City of Miami Beach: Yes [j or NO~hiCh department?
· Pursuant to City Code Section 2-25 (b): Do you have a parent ~, spouse 0, child 0, brother 0, or sister [J who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: years old Gender: Male~ Female 0
Ethnic Origin (Check one)
White 0 African-American/Black Oji'ispanic: 0 Asian or Pacific Islander 0 American Indian or Alaskan Native 0
Employment Status: Employed VRetired 0 Home-maker 0 Other 0
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
~
Applicant's Signak1"F"e
c7~~ 7
~te '
/Pc; .~.:~-oC/p
Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will remain on fiI or a period of one (1) calendar year.
Received in City Clerk's Office by
Datel
Date
2
F:\CLER\SALL\B&C ,l\ppJicati,:.n\,f.;(\C Appliulti('Il Revised 0911 Of) !2kcsdi)c