David Lehrman 12/31/2007 (2)
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Please list your preferences in order of ranking [1] first choice [2] next choice and 50 on __
(Regular Boards of City) (*Board Required to File State Disclosure forms)
[ ] Art in Public Places
[ ] Barrier Free Environment Committee
[ ] Beach Preservation Board
[ ] Beautification Committee
[ ] Board of Adjustment (fiood Mgmt.)*
[ ] Budget Advisory Committee
[ ] Code Enforcement Task Force
[ ] Committee on Homeless
[ ] Committee for Quality Education in MB
[ ] Community Development Advisory*
[ ] Community Relations Board
[ ] Convention Center Advisory Board
[ ] Convention Center Capital Projects Oversight
[ ] Debarment Committee
[ ] Design Review Board *
[ ] Fine Arts Board
[ ] Golf Advisory Committee
[ ] Health Advisory Committee
[ ] Health Facilities Authority
[ ] Hispanic Affairs Committee
[ ] Historic Preservation Board*
[ ] Housing Authority*
[ ] Loan Review Commlttee*
[ ] Marine Authority*
[ ] Miami Beach Cultural Arts Council
[ ] Miami Beach Commission on Status of Women
[ ] North Beach Youth Center Oversight Committee
[ ] Nuisance Abatement Board*
[ ] Oversight Committee for General Obligation Bond
[ ] Parks and Recreation Facilities Board
[ ] Personnel Board*
[ ] Planning Board*
[ ] Police Citizens Relations Committee
[ ] Production Industry Council
[ ] Safety Committee
[ ] South Point Advisory Board*
to Redeveiopment Agency
[ ] Te~rist aA~ CenvenlisA CeAter
Exl3aASisA Al::Itl=lSFity
[ ] Transportation and Parking Board
[ ] Visitor and Convention Authority*
[ 1- Youth Center Agyisory Board
G/) SiqQ,y C(I'f
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 [ ] (Years of Service [ ]
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.
This section is "not required" but desired: Age: [(;"1]
Ethnic Origirf(Check one)
White [V]' African-American/Black [ ] Hispanic: [ ]
Asian or Pacific Islander [ ] American Indian or Alaskan Native [
Employment Status: Employed [~tired [ ] Home-maker [
Child's name:
Child's name:
Age: _ Program:
Age: _ Program:
Gender: M ~r F [ ]
]
] Other [
y attest to the accuracy and truthfulness of the application and have reeived, read and Vvill abide by
r Article VII - of the City Glde "Standards of Conduct for City Officers, Iinployees and Agency
tll}./6') \D AU; d LA,rrnah,
3--:1,& ~~b Name of Applicant (PLEASE PRINT)
Attachment: Please attach a copy of your/resume to your application.
NOTE: Applications will remail)-GQ file for a pe od of one (1) calendar year.
Received in Ci Jerk's Office.u: /.0 / JJJ by \.. : Clerk
PLEASE NOTE TH~ THE REQUIREMENTS FOR BOAR MEMBE HIP DETAILED ON THIS APPUCATION
FORM MUST BE MAINTAINED BY CITY BOARD MEMBERS THROUGHOUT THEIR TENURE AS BOARD
MEMBERS. ANY CHANGES TO INFORMATION SUPPUED ON THIS APPUCATION FORM SHOULD BE
PROMPTLY PROVIDED BY BOARD MEMBERS TO THE CITY CLERK.
Document Control Number (Assigned by the City Clerk's Office)
C:\CMBWEB\JOBSIBCAPPUCI.DOC
Rev #6 - 6/01