Fort Walton Beach Council agenda — 02-12-08 regular agenda — reading text

YESYES _ _ A_A_ NONO OtherOther Board(Board( s)s) inin whichwhich youyou wouldwould bebe interestedinterested I amam aa residentresident ofof thethe City:City: YESYES NONO * * II HAVEHAVE BEENBEEN aa residentresident forfor 00 yearsyears 1 workwork inin thethe CRACRA District:District: YESYES NONO i ownown PP roProP ee dYdY inin thethe CRACRA District:District: YESYES NONO ** ** I amam aa registeredregistered voter:voter: YESYES NONO SIGNATURESIGNATURE ! ! IJAIJAWopWop DATEDATE II zP2zP2 77 cMcM OTE:OTE: ApplicationApplication effectiveeffective forfor ONEONE YEARYEAR fromfrom datedate ofof submission.submission. youyou havehave anyany questionsquestions onon thethe above,above, pleaseplease callcall thethe CityCity Clerk,Clerk, HelenHelen Spencer,Spencer, atat 833833 # # 833833 - - 95099509 oror thethe CityCity HallHall TDDTDD - - 99259925 rr nRMAVI^ nRMAVI^ uu OCIOCI nwnw CnRCnR II IcFIcF n1J1n1J1 YY RYRY THETHE CITYCITY AppointedAppointed to:to: LengthLength ofof Term:Term: DateDate ofof originaloriginal appointment:appointment: Date(Date( s)s) re-re- appointed:appointed:  CITY OF FORT WALTON BEACH APPLICATION TO SERVE On City Agencies, Authorities, Boards, Commissions or Committees Reference: Codified Ordinances of Fort Walton Beach - Section 2 -60) Name: SIC r- Home address: Sao 4 ` `' ' • d - - 4100 . E -ma + l: - ' v cKe r o d.. a.° Home phone: Business phone: Occupation: 1. Brief Resume of Education a d Experience Cr` A- d e 1 s cis 4 SiseL a 2. What options would you' itiate if appointed? " iSs s 42 a 1 , KIr v 42 a e a aC, 3. How you would address issues.if appointed / o j t7s-v r e. r !, 10 e e e Favu w " +•• -• .. — - - -- 4.0tit11.01% ANT vmr_yr IriG rwC.wwwars FIRE FIGHTERS' RETIREMENT POLICE OFFICERS' BEAUTIFICATION COMMITTEE FUND RETIREMENT FUND must be a resident must be a resident FWB HOUSING AUTHORITY MUNICIPAL PLANNING BOARD BOARD OF ADJUSTMENT must be a resident) must be a resident for 2 yrs and a registered voter) GOLF CLUB ADVISORY VISION PLAN STEWARDSHIP CODE ENFORCEMENT BOARD COMMITTEE COMMITTEE must be a resident) citizen- at-large must be a resident N- COMMUNITY REDEVELOPMENT HISTORIC SITES & ADVISORY AGENCY BOARD must be a City resident, own property or work in the district Do any circumstances/conditions exist which may inhibit your ability to be totally objective? __X NO YES 4. if una aYnlain• o 5. Until you are selected for the Board of your choice, may we submit your application when vacancies occur rather than contacting you? YES A __ NO, I wish to be contacted first. YES NO 7. Would you consider serving on another Board other than the one you selected above? Other Board(s) in which you would be interested I am a resident of the City: YES w, NO " I HAVE BEEN a resident for years I work in the CIA District: YES NO I own pro in the CRA District: YES X NO "` I a a inter voter: YES „A _ NO DATE ., 7f r3 G 7 NOTE: App ef%ctive for NE Y from date of submission. 833 -9925 If you have any questions on the above, lease call the City Clerk, Helen Spencer, at 833 -9509 or the City Hall TDD # INFORMATION BELOW FOR USE ONLY BY THE CITY Appointed to: Date of original a000intment: _ ___ Length of Term:  CITY OF FORT WALTON BEACH APPLICATION TO SERVE; On City Agencies, Authorities, Boards, Commissions or Committees Reference: Codified Ordinances of Fort Walton Beach - Section 2 -60) Name: 012 C Ime address: = ' • - ' me phone: E -mail: ccupation: Business phone: CQ .... rl d S7;;` P` 1. Brief Resume of Education and Experience ` - 2. What options would you initiate if appointed? 3. How you would address issues if appointed CHECK ANY ONE OF THE FOLLOWING please see other side of application for a brief description of duties FIRE, FIGHTERS' RETIREMENT POLICE OFFICERS' BEAUTIFICATION COMMITTEE FUND RETIREMENT FUND must be a resident) must be a resident) FWB HOUSING AUTHORITY MUNICIPAL PLANNING BOARD BOARD OF ADJUSTMENT must be a resident) must be a resident for 2 yrs and a registered voter) GOLF CLUB ADVISORY VISION PLAN STEWARDSHIP CODE