2020-09-21 Item VII.C. Ex 07REVISED 9/15/2020
MEMORANDUM
TO: Mayor Watford & Council Members DATE: September 10, 2020
FROM: City Clerk Gamiote SUBJECT: 9/21/20 Agenda Item-CCRAC
Applications
As instructed by the City Council, we advertised for City residents and/or property
owners to apply to serve on the City's Citizen Charter Review Advisory Committee
(CCRAC), for at least 60 -days. The applications are attached for your review and
consideration.
The City Council has the option of extending the application period or appointing the
eight -member committee from these applicants (seven regular members and one
alternate). The normal practice of the City after appointment is for the City Clerk to
officially notify them, provide them with the Citizen Board Handbook and ensure all
required forms are completed. Once an initial meeting date has been scheduled in
coordination with the City Attorney and Administrator, it will be advertised as will all
future meetings.
Names of applications attached:
Suzanne Bowen, resident & property owner
Noel A. Chandler, resident & property owner
Steve Dobbs, property owner
Jamie Gamiotea, resident & property owner
Jeremy R. LaRue, property owner
Sandy Perry, property owner
Cary Pigman, resident & property owner
Gary Ritter, resident & property owner
Myranda Whirls, resident & property owner
Hoot Worley, property owner
Please do not hesitate to call me with any questions or need any additional information.
M E M O R A N D U M
TO: Mayor Watford & Council Members DATE: September 10, 2020
FROM: City Clerk Gamiotea SUBJECT: 9/21/20 Agenda Item-CCRAC
Applications
As instructed by the City Council, we advertised for City residents and/or property
owners to apply to serve on the City’s Citizen Charter Review Advisory Committee
(CCRAC), for at least 60-days. The applications are attached for your review and
consideration.
The City Council has the option of extending the application period or appointing the
eight-member committee from these applicants (seven regular members and one
alternate). The normal practice of the City after appointment is for the City Clerk to
officially notify them, provide them with the Citizen Board Handbook and ensure all
required forms are completed. Once an initial meeting date has been scheduled in
coordination with the City Attorney and Administrator, it will be advertised as will all
future meetings.
Names of applications attached:
Suzanne Bowen, resident & property owner
Noel A. Chandler, resident & property owner
Steve Dobbs, property owner
Jamie Gamiotea, resident & property owner
Jeremy R. LaRue, property owner
Sandy Perry, property owner
Cary Pigman, resident & property owner
Myranda Whirls, resident & property owner
Hoot Worley, property owner
Please do not hesitate to call me with any questions or need any additional information.
N
W -l' 55
aw5 So t Su Avenue * Okeechobee * Florida * 34974 * (863) 763-3372
T
Tk rcnT
_ pl�t
&.._� Vor type all information. The information from this application will be used by the City
Council in considering action on your appointment The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "NIA" where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
0 Planning Board/Board of Adjustment & Appeals/Design Review Board Prb C(�
n
0 Okeechobee Utility Authority Board of Directors (City Residents Only)
0 Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee: 0 OR Fifth Member Trustee: 0
EI Other: Charter Review Committee El
APPLICANT'S FULL NAME:
Suzanne Bowen
NAME COMMONLY USED:
RESIDENCE ADDRESS:
700 SW 9th Street
HOW LONG AT ADDRESS:
Years: 2 Is this in the City Limits? 0 Yes 0 No
MAILING ADDRESS:
700 SW 9th Street
TELEPHONE/CELL:
561-529-907
EI Yes 0 No, explain:
ARE YOU AN US CITIZEN?
FLORIDA REGISTERED VOTER?
[2) Yes County Registered in:
0 No
EDUCATION:
High School Name & Location Year Graduated
Lemmon SID High School 1984
POST SECONDARY EDUCATION:
College Names) Certificate/Degree(s) Awarded Date(s) Attended
Saint Leo University Doctor of Business Administration 2015-2019
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
CURRENT OR MOST RECENT EMPLOYER:
Boral Industries
JOB TITLE/DESCRIPTION:
Senior Cost Accountant
WORK ADDRESS:
1289 NE 9th Ave, Okeechobee, FL 34972
WORK TELEPHONE:
863-824-1234
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor 0 Business Person 0 Architect
(CHECK./ ALL THAT APPLY)
0 Engineer 0 Sub -Contractor 0 Realtor
13 Attorney n Doctor 0 Surveyor
El Lay Person 0 Urban Planner 0 Landscape Architect
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? No ❑ Yes, and list:
AGENCY. BOARD NAME POSITION DATES)
Are you now, or have you ever been, elected or appointed to any public office? I0No ❑ Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERMS)
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? 1A No 0 Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? No ❑ Yes, and
list:
NAME OF EMPLOYEEIELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part 111, Code of Ethics for Public Officers
and Employees? No ❑ Yes, and list:
DATE (S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? No ❑ Yes, and list:
DATE(S) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from nublic records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. No 0 Yes, and list:
J05 TITLE OR COVERED POSITION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
I have been a general accountant for over 30 years and recently obtained my Doctor of Business Administration.
This degree would be more usable if I put my knowledge to use outside private businesses and allow me to network outside my workgroup.
My husband Reggie Bowen has recently opened an Okeechobee business so we are interested
in the inner -workings of the city in which we are investing our time and money.
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: D MALE 0 FEMALE
ETHNIC GROUP: IN CAUCASIAN D BLACK D SPANISH HERITAGE D NATIVE AMERICAN
, D ASIAN OR PACIFIC ISLANDER D OTHER(specify):
,/ALL THAT APPLY: D WARTIME PERIOD VETERAN D DISABLED VETERAN
D VIETNAM VETERAN
HANDICAPPED STATUS: 0 NO DYES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: |certify that the answers are true and complete hothe best nfmy knowledge.|authorize
investigation of all statements contained in this application. | hereby release all comopuniea, euh000, orpersons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the [)fhma of the City Clerk. | further understand all information provided becomes n matter of public
record.
CERTIFICATION: | understand that falsifivaUon, omisoion, misleading mbab*mento, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: | understand that should |be appointed tomCity of Okeechobee citizen board |
mnn required to complete and fila a State of Florida Financial Disclosure Form 1 upon my appointment, annually and e
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC MEETINGS LAWS: | understand and agree that should | be appointed to e citizen
board/committee for the City ofOkeechobee, | will comply with all State 8tmtuteo, Florida Administrative Code. and State
Constitution regarding public raoordo, records rabanUnn, public record requmata, and the open public meeting
requirements.
| hereby acknowledge that |h e read and understand each of the above statements.
Signature ofApplicant: Dahe �
1.The City Code Book Sec. 7D -151,7O -171.7O -1917O-211 read: ^....nnennbenahipofthe board, where possible, shall
consist of any of the following: mvch|heot, engineer, surveyor, urban planner, landscape mnohiteot, general contractor,
pea|tor.business person, and lay parauno.^
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation ofUcerm, ouperv/mons, detention superintendents and assistants; Department of Juvenile Justice:
detention officers | and ||, detention office eupenvisure, residential offiuere, residential officer supervisors | and ||,
counselors and ouparvinora, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of. the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Bua|naaa and Professional Regulation; the Cffioe of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative |ovx judges of the Divisions of Administrative HeohnOa, and
child support enforcement hearing officers; state attorneys and anoiebonta, ebotwvodm pnmemcuhuna and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians od|itenn;human resource,
labor relations, or employee relations directors and aeoiatanto, managers or assistant managers ofany local government
agency or water management district whose duties include hiring and firing employees, labor contract negobaUono,
administration, or other personnel -related duties; tax ooUmoboro; umdoin impaired practitioners and consultants; [see
§119.071. Florida Statues).
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3 RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
CITY CLERKS OFFICE USE ONLY
APPOINTED TO:
CITY COUNCIL INITIAL TERM NOTIFICATION
MEETING: DATES: SENT:
RE -APPOINTED TERM RE -APPOINTMENT RESIGNEDITERM CERTIFICATE OF
DATES: NOTIFICATION SENT: SUNSET: APPRECIATION PRESENTED:
CITY OF OKEECHOBEE
55 Southeast 3 Id Avenue * Okeechobee * Florida * 34974 * (863) 763-3372
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APPOINTMENT
Please print or type all information. The information from this application will be used by the City
Council in considering action on your appointment. The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "NIA "where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
0 Planning Board/Board of Adjustment & Appeals/Design Review Board fni tat 11
0 Okeechobee Utility Authority Board of Directors(City Residents Only) pouiv
0 Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee: - ----- 0____ OR Fifth Member Trustee:,
EI Other: Charter Review Committee
APPLICANT'S FULL NAME:
Noel A. Chandler
NAME COMMONLY USED:
Noel
RESIDENCE ADDRESS:
1007 SW 6th Avenue, Okeechobee, FL 34974
HOW LONG AT ADDRESS:
Years: 50 Is this in the City Limits? EaYes ONo
MAILING ADDRESS:
1007 SW 6th Avenue, Okeechobee, FL 34974
TELEPHONE/CELL:
863-634-0646
ARE YOU AN US CITIZEN?
El Yes 0 No, explain:
FLORIDA REGISTERED VOTER?
EI Yes County Registered in: Okeechobee
11 No
EDUCATION:
High School Name & Location Year Graduated
Okeechobee High School 1965
POST SECONDARY EDUCATION:
College Narne(s) Certificate/Degree(s) Awarded Date(s) Attended
N/A N/A N/A
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
US Navy 1966-1969 1969
CURRENT OR MOST RECENT EMPLOYER:
B&B Site Development
JOB TITLE/DESCRIPTION:
Retired
WORK ADDRESS:
1505 South Parrott Avenue, Okeechobee, FL 34974
WORK TELEPHONE:
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor 0 Business Person 11 Architect
(CHECK./ ALL THAT APPLY)
0 Engineer 0 Sub -Contractor D Realtor
0 Attorney 0 Doctor El Surveyor
EI Lay Person 0 Urban Planner 0 Landscape Architect
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? ❑ No 0 Yes, and list:
AGENCY BOARD NAME POSITION DATE(S)
Airboat Association of Okeechobee N/A President 1970's
City of Okeechobee & BOCC Tourist Development Council Liaison Board Member City: 1994-2002a0144019, eocc:2u0&2010
City of Okeechobee & BOCC Central Florida Regional Planning Council Liaison Board Member City. 1994-2002/2014-2010, aocC:2006-2010
Are you now, or have you ever been, elected or appointed to any public office? ❑ No 0 Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
City of Okeechobee City Council 11/1994,1998,2002, 2014 01/1995 -1112006.01/2015 - Current
Board of County Commissioners County Commissioner 11/2006 11/2006 - 11/2010
Okeechobee Utility Authority Board Member
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? 0 No' ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? ❑ No 0 Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Can be provided upon request. Distant relatives, none that would fall under the nepotism laws.
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part III, Code of Ethics for Public Officers
and Employees? 0 No ❑ Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? 0 No ❑ Yes, and list:
DATES VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. 0 No ❑ Yes, and list:
JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
Applicant will provide any information requested.
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: El MALE D FEMALE
ETHNIC GROUP: El CAUCASIAN D BLACK D SPANISH HERITAGE D NATIVE AMERICAN
D ASIAN OR PACIFIC ISLANDER D OTHER(specify):
✓ALL THAT APPLY: El WARTIME PERIOD VETERAN D DISABLED VETERAN
D VIETNAM VETERAN
HANDICAPPED STATUS: EINO DYES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. 1 further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that I have read and understand each of the above statements.
wrli
Signature of Applicant:'* Date:
1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: ....membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and II, detention office supervisors, residential officers, residential officer supervisors I and II,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
55 Southeast 3" Avenue * Okeechobee * Florida * 34974 * (8;63-3337VT
S,
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APP
Please print or type all information. The information from this application will be used - Rylthe City
Council in considering action on your appointment. The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "NIA" where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
0 Planning Board/Board of Adjustment & Appeals/Design Review Board pfq�r
0 Okeechobee Utility Authority Board of Directors (City Residents Only)
0 Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee: --_0.-_-- OR Fifth Member Trustee:____0____)
121 Other: Charter Review Committee
APPLICANT'S FULL NAME:
Steven L. Dobbs
NAME COMMONLY USED:
RESIDENCE ADDRESS:
1062 Jakes Way, Okeechobee, FL 34974
HOW LONG AT ADDRESS:
Years: 20 Is this in the City Limits? OYes EINo
MAILING ADDRESS:
Same
TELEPHONE/CELL:
863-634-0194
ARE YOU AN US CITIZEN?
0 Yes 0 No, explain:
FLORIDA REGISTERED VOTER?
El Yes County Registered in: Glades
11 No
EDUCATION:
High School Name & Location Year Graduated
Ed White Senior High School 1982
POST SECONDARY EDUCATION:
College Name(s) Certificate/De-gree(s) Awarded Date(s) Attended
OF Ag Engineering 1982-1989
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
CURRENT OR MOST RECENT EMPLOYER:
Steven L. Dobbs Engineering, LLC
JOB TITLE/DESCRIPTION:
President
WORK ADDRESS:
209 NE 2nd Street
WORK TELEPHONE:
863-824-7644
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor r7l Business Person 0 Architect
(CHECK V ALL THAT APPLY)
0 Engineer El Sub -Contractor 0 Realtor
1
0 Attorney 0 Doctor 0 Surveyor
0 Lay Person 0 Urban Planner 0 Landscape Architect
6=1
I
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? ❑ No 0 Yes, and list:
AGENCY BOARD NAME POSITION DATES)
Glades County Planning Board Chairman 2008 - Present
Are you now, or have you ever been, elected or appointed to any public office? El No ❑ Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? ❑ No ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER($) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? ❑ No El Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Wes Abney - City Council Business Partner
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part 111, Code of Ethics for Public Officers
and Employees? 0 No ❑ Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? El No ❑ Yes, and list:
DATE (Q VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. IZI No ❑ Yes, and list:
JOB TITLE QR QQVEREQ P0,$jT1Qtj TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
I have been an engineer for over 30 years and have been a part of many organizations for many years. I have had to plan, budget,
schedule, review City, County, State, and Federal Codes, business contracts, and legal documents my entire career to determine
compliance of Me job funcitons we were working on at the time. 1 have
f4elwithm),3 9iGXPQ4:"-PQG I '14,0411d bean asset 10 committce to settbG C4 Qfokeechahec tobc solvapt apd able to meet
the needs of the residents and business owners into the future.
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: 0 MALE 0 FEMALE
ETHNIC GROUP: O CAUCASIAN 0 BLACK 0 SPANISH HERITAGE 0 NATIVE AMERICAN
0 ASIAN OR PACIFIC ISLANDER 0 OTHER(specify):
✓ALL THAT APPLY: 0 WARTIME PERIOD VETERAN 0 DISABLED VETERAN
0 VIETNAM VETERAN
HANDICAPPED STATUS. 0 NO 0 YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that I have readAnd, understand each of the above statements.
Signature of Applicant: Date: 17 000
1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: "....membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and 11, detention office supervisors, residential officers, residential officer supervisors I and 11,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
CITY CLERKS OFFICE USE ONLY
APPOINTED TO:
CITY COUNCIL INITIAL TERM NOTIFICATION RE -APPOINTED TERM RE -APPOINTMENT RESIGNEDITERM CERTIFICATE OF
MEETING: DATES: SENT: DATES: NOTIFICATION SENT: SUNSET: APPRECIATION PRESENTED:
CITY OF OKEECHOBEE
55 Southeast 3' Avenue * Okeechobee * Florida * 34974 * (863) 763-3372
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APPOINTMENT
Please print or type all information. The information from this application will be used by the City
Council in considering action on your appointment. The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "N/A" where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
0 Planning Board/Board of Adjustment & Appeals/Design Review Board asidaiHm a_
0 Okeechobee Utility Authority Board of Directors (City Residents Only) 69
0 Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee:.,,_0__. OR Fifth Member Trustee: _ -_q____)
El Other: Charter Review Committee
APPLICANT'S FULL NAME:
James C. Gamiotea
NAME COMMONLY USED:
Jamie Gamiotea
RESIDENCE ADDRESS:
Mn & WA qa-
HOW LONG AT ADDRESS:
Years: 28 Is this in the City Limits? ElYes ONo
MAILING ADDRESS:
same as above
TELEPHONE/CELL:
_UW� //01. 0 7/ 1,q) jd) j, 0
ARE YOU AN US CITIZEN?
El Yes 0 No, explain:
FLORIDA REGISTERED VOTER?
El Yes County Registered in: Okeechobee
0 No
EDUCATION:
High School Name & Location Year Graduated
DeSoto, Arcadia, FL June 1987
POST SECONDARY EDUCATION:
College Name(s) Certificate/Degree(s) Awarded Date(s) Attended
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
USMC 1987-1991 1991 -Honorable
CURRENT OR MOST RECENT EMPLOYER:
Okeechobee Utility Authority
JOB TITLE/DESCRIPTION:
Wastewater Supervisor
WORK ADDRESS:
1335 NE 39th Blvd. Okeechobee, FL 34972
WORK TELEPHONE:
863-763-3322
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor 0 Business Person OArchitect
(CHECK./ ALL THAT APPLY)
0 Engineer 0 Sub -Contractor 0 Realtor
0 Attorney 0 Doctor 11 Surveyor
El Lay Person 0 Urban Planner 0 Landscape Architect
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? ❑ No O Yes, and list:
AGENCY BOARD NAME POSITION DATE(S)
City of Okeechobee Code Enforcement Member, Vka Ch-81 I W02-5 13108 & Chair 5113108.10018 5/1/1999 - 10/2/2018
City of Okeechobee Park Committee Vice Chair 10/18/2011 - 3/1/2012
Are you now, or have you ever been, elected or appointed to any public office? D No ❑ Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? ❑ No ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
N/A - Unknown at this time.
Are you related to, or employed by, any City of Okeechobee employees or elected officials? ❑ No E) Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
e rg ,W/l rs. /19 �?�rlY)ld��,a
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part III, Code of Ethics for Public Officers
and Employees? 0 No ❑ Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? El No ❑ Yes, and list:
DATES) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. ❑ No r—ff Yes, an i�'st.
JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP
Law Enforcement Officer self
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
I fully believe that civil engagement is the backbone to any sucessful community which is why I have been actively
volunteering since moving here in August 1992, coaching several leagues of the OCRA Girls Softball (1992-1995),
high school swim team assistant coach (2008-2013 & 2018 -present), City of Okeechobee Police Auxiliary
Member (1997 -present). Active member of multiple committees in my church, First Baptist of Okeechobee.
During my 19 years of service on the City's Code Enforcement Board I had the opportunity to attend many training courses and
conferences related specifically to parliamentary procedures and how to run effective board meetings, not to mention the
education and wisdom one obtains from sitting in the Chairperson's seat for over 10 years.
Due to my career, and 23+ years on the Police Auxiliary I understand how local government functions from the required
procurement procedures, the various protocols to follow, and the role of home rule power for municipalities in our State.
I am a fifth generation Floridian, and greatly appreciate our State's unique history.
I would consider it an honor to serve on such an important committee as this group will serve.
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: 0 MALE ❑ FEMALE
ETHNIC GROUP: El CAUCASIAN ❑ BLACK El SPANISH HERITAGE ❑ NATIVE AMERICAN
❑ ASIAN OR PACIFIC ISLANDER ❑ OTHER(specify):
./ALL THAT APPLY: El WARTIME PERIOD VETERAN ❑ DISABLED VETERAN
❑ VIETNAM VETERAN
HANDICAPPED STATUS: EINO 0 YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that I hare' dad -and under%anTeao of the above statements.
Signature of Applica
X
Date:{ti
1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and II, detention office supervisors, residential officers, residential officer supervisors I and II,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
55 Southeast 3`d Avenue * Okeechobee * Florida * 34974
F9
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE AP
was=
PCC_
Please print or type all information. The information from this application will be used by the City
Council in considering action on your appointment. The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "N/A" where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
❑ Planning Board/Board of Adjustment & Appeals/Design Review Board
Owaff
❑ Okeechobee Utility Authority Board of Directors (city Residents only) proptf�
❑ Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee: OR Fifth Member Trustee: )
❑ Other:_ C C_
APPLICANT'S FULL NAME:
�Q
NAME COMMONLY USED:
RESIDENCE ADDRESS:
HOW LONG AT ADDRESS:
Years:,,;I,, Is this in the City Limits? ❑ Yes O'No
MAILING ADDRESS:
TELEPHONE/CELL:
/ �yqa
ARE YOU AN US CITIZEN?
WrYes ❑ No, explain:
FLORIDA REGISTERED VOTER?
@Yes County Registered in: 0.1,'eec4obee
Q No
EDUCATION:
High School Name & Location Year Graduated
0eec ®'79:5"
POST SECONDARY EDUCATION:
college Names) Certificate/Degree(s) Awarded Date(s) Attended
°8 Qac
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
CURRENT OR MOST RECENT EMPLOYER:i
0 oAP07 -S 'Pt) 0,e' ,
JOB TITLE/DESCRIPTION:
WORK ADDRESS:
?� ("g� t�t�� t7 (0 00eee-4r7 �e-c. &(— :?gg17,;?'
WORK TELEPHONE:�3
° ARE YOU CURRENTLY EMPLOYED AS:
❑ General Contractor Business Person ❑ Architect
(CHECK ✓ ALL THAT APPLY)
❑ Engineer ❑ Sub -Contractor ❑ Realtor
❑ Attorney ❑ Doctor ❑ Surveyor
❑ Lay Person ❑ Urban Planner 0 Landscape Architect
PCC_
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? No ❑ Yes, and list:
AGENCY
BOARD NAME
POSITION
Are you now, or have you ever been, elected or appointed to any public office? P No
LEVEL OF GOVERNMENT OFFICE TITLE
DATE OF ELECTION
DATE(S)
11 Yes, and list:
TERM(S)
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? �FNo ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? AA No ❑ Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part 111, Code of Ethics for Public Officers
and Employees? No ❑ Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? 'A No ❑ Yes, and list:
DATE(S) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure_ under Florida Statute 119.071? Review list of other covered employees before
responding. 13No es, and list
JOB TITLE OR COVERED POSITION TITLE
oe«C-tia)he-c c; V,/
RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
T p c iJ ` t�r� 0 Per -4--c Il 42S; A3 e SSS' S
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: 14 ``MALE a FEMALE
ETHNIC GROUP: '� CAUCASIAN ❑ BLACK a SPANISH HERITAGE ❑ NATIVE AMERICAN
❑ ASIAN OR PACIFIC ISLANDER ❑ OTHER(specify):
./ALL THAT APPLY: Eli WARTIME PERIOD VETERAN ❑ DISABLED VETERAN
❑ VIETNAM VETERAN
HANDICAPPED STATUS: NO ❑ YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: 1 understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the: City of Okeechobee, I will comply with all State Statutes, Florida Administrative Cade, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that() have read and
Signature of
each of the above statements.
Date: /13 12020
1. The City Code BookWc. 70-151 70-171, 70-19170-211 read: ....membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and II, detention office supervisors, residential officers, residential officer supervisors I and II,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
CITY CLERKS OFFICE USE ONLY
APPOINTED TO:
CITY COUNCIL INITIAL TERM NOTIFICATION RE -APPOINTED TERM RE -APPOINTMENT RESIGNEDITERM CERTIFICATE OF
MEETING: DATES: SENT: DATES: NOTIFICATION SENT: SUNSET: APPRECIATION PRESENTED:
CITY OF OKEECHOBEE
55 Southeast 3"Avenue * Okeechobee * Florida * 34974 * (863) 763-3372
Please print or type all information. The information from this application will be use�_,
Council in considering action on your appointment. The application MUST BE CdWz1)1
FULL. Answer "None" "Not Applicable" or "NIA" where appropriate. xn
A
CHECK (0) THE BOARD(S) OF INTEREST TO You Iq
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATT ED
[3 Planning Board/Board of Adjustment & Appeals/Design Review Board
• Okeechobee Utility Authority Board of Directors (city Residents Only)
• Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trus
(City Resident Trustee:_0 OR Fifth Member Trustee: 0 )
Select OtherI mr-e, OMAN
f- (2
19 Other: e SA -1 MM -X-4
1 1
APPLICANT'S FULL NAME:
Sandwa V1. 10
NAME COMMONLY USED:
RESIDENCE ADDRESS:()J
-ee
_chober_3�91?�
HOW LONG AT ADDRESS:
Years: Is this in the City Limits? MYes ONo
MAILING ADDRESS:
-e
TELEPHONE/CELL:
7? 7)
ARE YOU AN US CITIZEN?
19 -Yes 0 No, explain:
FLORIDA REGISTERED VOTER?
10 Yes County Registered in:
0
0 No c&
EDUCATION:
High School Name & Location Year Gra uat
0 � LG e e- e / 01,720
POST SECONDARY EDUCATION:
Colleg Nanne(s) Cert"te/De4ree(s ttended
'it
r (�(f �,p V AV -7 � 'sll 60,ClAda(
M+HTARY-8EfkV4eE—_
l3__AA9§4_
C-��
FA U fl) .acts 1,6 dutq
k)�;.212'A . A N dwu,`ks
CURRENT OR MOST RECENT EMPLOYER:
e V, A 40 n t, �qilaij-tvl w5upevv i
tot's IV,.
JOB TITLE/DESCRIPTION:
1A0,1A0APMeW� 6AM
WORK ADDRESS:
)IPA I y k U
WORK TELEPHONE:
)(of
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor 111111 Business Person OArchitect
(CHECK./ ALL THAT APPLY)
0 Engineer [3 Sub -Contractor 0 Realtor
0 Attorney [3 Doctor E3 Surveyor
[3 Lay Person n Urban Planner [3 Landscape Architect
16f76s
(olfe Je5se, COO 1�� -ny-roa6)
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? No ❑ Yes, and list:
AGENCY BOARD NAME POSITION DATE(S)
Are you now, or have you ever been, elected or appointed to any public office? M No ❑ Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? III No ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? F No ❑ Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part III, Code of Ethics for Public Officers
and Employees? bNo ❑ Yes, and list:
DATES NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? W No ❑ Yes, and list:
DATE(S) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. 1p No ❑ Yes, and list:
JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
My parents graduated from Okeechobee High School as I did along with my 3
sisters. I take pride in our city and county and get involved in civic associations
as I am a long-standing member of the Okeechobee Cattlemen's Association,
the Okeechobee Ministerial Association and the Economic Council, where I
currently serve on the Board of Directors. I also have been the pianist for
Okeechobee Presbyterian for 10 years and Northside Baptist since for 20
years. I have had the opportunity and privilege to be the director of the
Okeechobee Community Choir since 1999 with numerous performance each
year and look forward to reconvening it when our "New Normal" phase ends!
Jennifer Tewksberry, the Executive Director of the Economic Council, asked
for interested participants in the City Charter Review process and I offered to
apply. My educational and professional background, especially in special
education and administration, has provided me numerable opportunities over
the past 45 years to be involved in reviewing, critiquing, and writing various
programs and procedures in a logical and thorough manner. I utilize a well -
reasoned and sequential approach due to years of teaching students and adults
and training employees. While at Okeechobee Health Care Facility for the past
22 years, I have been involved in advertising, policy revision and creation,
calendar and newsletter development, website editing and daily management.
I look forward to assisting in the review of the City of Okeechobee Charter.
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: ❑ MALE 91 FEMALE
ETHNIC GROUP: 12 CAUCASIAN ❑ BLACK ❑ SPANISH HERITAGE ❑ NATIVE AMERICAN
❑ ASIAN OR PACIFIC ISLANDER ❑ OTHER(specify):
/ALL THAT APPLY: ❑ WARTIME PERIOD VETERAN ® DISABLED VETERAN
❑ VIETNAM VETERAN
HANDICAPPED STATUS: RNO 0 YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements. _
I hereby acknowledge nderspand eac of a above s tements.
zy,
ll �
Signature of Applicant. Date: e
1. The City Code Book Sec. 0-151, 70-171, 70-19170-211 read: "....membership of the board, where possible, shall
consist of any of the fe Ing: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers 1 and 11, detention office supervisors, residential officers, residential officer supervisors I and 11,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
CITY CLERKS OFFICE USE ONLY
APPOINTED TO:
CITY COUNCIL INITIAL TERM NOTIFICATION RE -APPOINTED TERM RE -APPOINTMENT RESIGNEDITERM CERTIFICATE OF
MEETING: DATES: SENT: DATES: NOTIFICATION SENT: SUNSET: APPRECIATION PRESENTED:
RESUME
Sandra (Sandy) W. Perry
3285 SW 28th ST
Okeechobee, FL 34974
(863) 634-7714
Education
1983-1986 University of South Florida Sarasota, FL
Post -Graduate Study
Administration/Supervision Certification
33 Semester Hours — GPA 3.9
1975-1978 Florida Atlantic University Boca Raton, FL
M.A. in Learning Disabilities Grades K-12
Certification in Music Education Grades K-12
GPA 4.0
1970-1975 Florida State University Tallahassee, FL
B.S. in Music Therapy
GPA 3.5
Experience Summary
In my forty-five+ years of professional experience, I have had the opportunity to work with
students, employees and residents ranging in age from three to 107. 1 approach
assignments and responsibilities with an energetic zeal and a focus on thoroughness,
accuracy and improving work -environment organization resulting in improved time -
efficiency. I also enjoy interpersonal interactions utilizing a compassionate, educational,
and humorous manner. I'm proud to work along side my mother who, with my father, built
Okeechobee Health Care Facility in '82-'83, opening in December of 1984 with 90 beds and
two Wings; A and B Wings. Additional beds have been added over the years with several
additions to C wing as they became available from the State through the Treasure Coast
Health Council resulting in our current 180 resident beds. D wing is being constructed at
this time to include 25 private rooms. A 2 -time, 5 -Star and Governor's Gold -Seal Facility,
we employ 285 employees. In January, we received another excellent ARCA survey and in
March had our first JCACO inspection and was awarded Joint Commission Accreditation
and Certification in Health Care Centers. We have worked closely with IRSC the past 36
years, making the facility available for clinical practice and hiring nursing graduates.
Professional Experience
1998- Administrator-in-Training/Assistant Administrator Seniors "R" Able (SRA) a management
Present company for Okeechobee Health Care Facility (OHCF), Community Liaison & Benefits
Manager for SRA and OHCF
1998-2004 Coordinator/Biller of Dunklin Assisted Living and Adult Daycare
Coordinated program provided to 20 in-house residents and numerous daycare
clients involving billing, dietary, activities, and day-to-day management
2002-2005 Principal of The Academy at Okeechobee Health Care Facility
Managed an in -facility State Certified Nursing Assistant training program
1997-1998 Assistant Principal of 1,200 students
Dealt with general education students referred for behavioral issues
Managed a sizeable special education department as the school housed the north Fulton
county center -based programs for moderately and profoundly -handicapped students and
special education programs ranging from gifted to learning disabled
Alpharetta Elementary
Alpharetta, GA
1994-1997 Instructional Support Teacher
Managed 18 special education teachers and completed diagnostic testing of students
evaluated for potential special education placement
Alpharetta Elementary
Alpharetta, GA
1987-1994 Student Support Teacher Age 3 -Grade 12 Fulton County Schools
Managed all Special Education teachers
Monitored and executed meetings with parents and teachers of under -performing students
to review progress, develop classroom & home strategies and complete evaluation
workup, if needed
Roswell High, Haynes Bridge Middle, Kimball Bridge Elementary
Roswell and Alpharetta, GA
1986-1987 Music Teacher Fulton County Schools Grades K-7
Charles Riley Elementary, M.P. Word Elementary, & Evelyn West Elementary
Atlanta, GA
1985-1986 Curriculum Resource Teacher / Music Teacher
Developed Organizational and Time Management strategies for under -performing gifted
students and taught music to students in grades 2-4
Pine View School for the Gifted Grades 2 —12
Sarasota, FL
1979-1985 Teacher of Learning Disabled (LD) students (Grades K-6)
Brentwood Elementary
Sarasota, FL
1978-1979 Program Specialist for Exceptional Student Education (ESE)
School Board of St. Lucie County
Fort Pierce, FL
1977-1978 Classroom Teacher for Learning Disabled Students (Grades K -6)
Department Head — Learning Disabilities for all LD Teachers
Lawnwood Elementary and all schools in St. Lucie County
Fort Pierce, FL
1975-1977 Classroom Teacher for Learning Disabled Students (Grades K-6)
Lawnwood Elementary
Fort Pierce, FL
3/75-6/75 Music Therapist for all Self -Contained ESE Classes (Grades K-12)
School Board of St. Lucie County
Fort Pierce, FL
2
8/74-3/75 (Internship) Music Therapist & Support Teacher for Severely Emotionally Handicapped
Students
The Rutland Center and Georgia Retardation Center
Athens, GA
Current Professional & Community Activities
99 -Present Director of Okeechobee Community Choir
Volunteer 50+ voice Community Choir which presents an annual Christmas and Easter
Cantata as well as performing at Easter Sunrise & 5th Sunday community -wide services
01 -Present Member, Choir Director and Pianist Northside Baptist Church
00-08 School Readiness Coalition board member representing Okeechobee County
Non-profit organization for subsidized daycare responsible for the administration of $14
million -dollar budget for 3 -county area
President of Okeechobee Coalition 04; Treasurer of Okeechobee Coalition 02-04
00 -Present Economic Council of Okeechobee County
02 -Present Economic Council of Okeechobee County Board Member, with 3 roll -off years
Chairperson of Quality of Life Committee majority of those years
06 -Present Member of Sheriff's Posse of Okeechobee County
09 -Present Board Member and Secretary of Okeechobee Ministerial Association
11 -Present Pianist for Sunday Church Services at Okeechobee Health Care Facility and Okeechobee
Presbyterian Church
16 -Present Board Member of Okeechobee County Cattlemen's Association
Previous Professional & Community Activities
1989-1998 Director of Fulton County Volunteer Employees' Chorus
Atlanta, GA
1992-1998 Member of Crabapple Baptist Church and Youth Choir Director
Alpharetta, GA
1996-1997 President of Special Education Professional Organization
Atlanta, GA
1985 Member of District -Level ESE Ad Hoc Review Committee
Sarasota, FL
1980 School Board of Sarasota County District Representative to State of Florida Task Force to
develop Standards for LD Students
Sarasota, FL
1980-1986 Pianist for Bee Ridge Presbyterian Church
Sarasota, FL
1982-1984 Accompanist for Sarasota Boys' Choir
1978 Guest Lecturer on Music Therapy
Florida Atlantic University
Awards
1997 Outstanding Special Education Teacher of Fulton County
1984 Nominated for Brentwood Elementary Teacher of the Year
Numerous Letters of Appreciation from Parents of former students
Hobbies
Choral Singing, Choir Directing, Playing Racquetball, Growing Roses,
Riding Horses, Scuba Diving and Ranching
CITY OF OKEECHOBEE
55 Southeast 3r Avenue * Okeechobee * Florida * 34974 * (863) 763-3372
Please print or type all information. The information from this application will b b)6th4%&Cit
Council in considering action on your appointment. The application MUST B#
PULL. Answer "None" "Not Applicable" or "N/A° where appropriate. A 1 In
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTIA
• Planning Board/Board of Adjustment & Appeals/Design Review Board
• Okeechobee Utility Authority Board of Directors (City Residents Only)
• Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee:- OR Fifth Mepl�er Trustee: 0 t
�,ft'l
V—Other: Select Other C% CL- 1-1,,e L"
APPLICANT'S FULL NAME:
6-J Lv C
NAME COMMONLY USED:
C& V I/ \, &,A,
RESIDENCE ADDRESS:
SLd' q- 4-L,' A t/,e- (9
HOW LONG AT ADDRESS:
Years: q Is this in the City Limits? kes [I No
MAILING ADDRESS:
51 ... -e
TELEPHONE/CELL:
00 & -7 2 S- � to yt-
ARE YOU AN US CITIZEN?
I;Kyes 0 No, explain:
FLORIDA REGISTERED VOTER?
EI(Yes County Registered in: oVeelc-erll',
bNo
EDUCATION:
High School Name & Location Year Graduated
c-eLd, Loc,..\ L 0 LA t PL
r
POST SECONDARY EDUCATION:
Coileg Name(s) Certificate/Degreefs) Awarded Date(s) Attended
u 1U. -D
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
LA_ 5, tj f2- /T(9 t V, C CLIL
LA. -I-)- e S a0 to &4_CV1l(eLA_%
CURRENT OR MOST RECENT EMPLOYER:
GA_ 5' Vq C- 5
JOB TITLE/DESCRIPTION:
6
e_144,e ,-* L C LL,—
, C
WORK ADDRESS:
V
eflulei&e4A
440,_k:44 ctr t4 -e (1-GA41
WORK TELEPHONE:
(o -3 ). le) -3 6,
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor 0 Business Person [3Architect
(CHECKV ALL THAT APPLY)
0 Engineer [3 Sub -Contractor 0 Realtor
0 Attorney 0-goctor 0 Surveyor
0 Lay Person 13 Urban Planner 0 Landscape Architect
I'
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? tif No ❑ Yes, and list:
AGENCY BOARD NAME POSITION DATE(S)
Are you now, or have you ever been, elected or appointed to any public office? ❑ NoYes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
CA
-D: ,.�& ao\LL 1
yolCo
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? 91 -No ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? 610 ❑ Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been f u d to be in violation of Florida Statutes Chapter 112, Part 111, Code of Ethics for Public Officers
and Employees? UNo ❑ Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no Contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? OUNo ❑ Yes, and list:
DATES VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from Public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. UNO ❑ Yes, and list:
JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page..
l atQ L9 v'lldg70
o pL e to v. e,,,ep-t—' tl�er LA -a "
��w� Cb- `CIVW wt
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: WMALE 0 FEMALE
ETHNIC GROUP: PAUCASIAN 0 BLACK 0 SPANISH HERITAGE 0 NATIVE AMERICAN
0 ASIAN OR PACIFIC ISLANDER 0 OTHER{specify}:
✓ALL THAT APPLY: ARTIME PERIOD VETERAN 0 DISABLED VETERAN
O VIETNAM VETERAN
HANDICAPPED STATUS: NO 0 YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: 1 certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should 1 be appointed to a citizen
board/committee for the City of Okeechobee, 1 will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that I have re un each of the above statements.
Signature of Applicant: Date: Q �/! �'�' 7"::�
1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and 11, detention office supervisors, residential officers, residential officer supervisors I and II,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
G � e'(O'A
55 Southeast 3rAvenueOkeechobee Florida 34974 76 "1
37�
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE AP TMENT
Please print or type all information. The information from this application will be used by the City
Council in considering action on your appointment The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "NIA" where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
0 Planning Board/Board of Adjustment & Appeals/Design Review Board
0 Okeechobee Utility Authority Board of Directors (city Residents Only)
0 Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee: OR Fifth Member Trustee: ___p___
El Other: Charter Review Committee
APPLICANT'S FULL NAME:
Gary Ritter
NAME COMMONLY USED:
Gary Ritter
RESIDENCE ADDRESS:
1950 SW 5th Ave, Okeechobee, FL 34974
HOW LONG AT ADDRESS:
Years: 28 Is this in the City Limits? EIYes ONo
MAILING ADDRESS:
1950 SW 5th Ave, Okeechobee, FL 34974
TELEPHONE/CELL:
863-610-1562
ARE YOU AN US CITIZEN?
El Yes 0 No, explain:
FLORIDA REGISTERED VOTER?
EI Yes County Registered in: Okeechobee
11 No
EDUCATION:
High School Name & Location Year Graduated
Boca Raton High 1972
POST SECONDARY EDUCATION:
College Name(s) Certificate/Degree(s) Awarded Date(s) Attended
U of Florida Bachelor of Science 1977
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
CURRENT OR MOST RECENT EMPLOYER:
Florida Farm Bureau Federation
JOB TITLE/DESCRIPTION:
Assistant Dir. of Govern ment&Com mu nity Affairs
WORK ADDRESS:
1950 SW 5th Ave, Okeechobee, FL
WORK TELEPHONE:
352-727-0547
ARE YOU CURRENTLY EMPLOYED AS:
0 General Contractor El Business Person OArchitect
(CHECK./ ALL THAT APPLY)
0 Engineer 0 Sub -Contractor E3 Realtor
0 Attorney 0 Doctor 13 Surveyor
Lay Person 0 Urban Planner 0 Landscape Architect
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? ❑ No ❑ Yes, and list:
AGENCY BOARD NAME POSITION DATE(S)
Raulerson Hospital Board of Trustees Board Member 2012 to Current
Center State Bank Bank Board Board Member 2017 to Current
City of Okee Planning and Zoning Planning and Zoning Board Board Member 2012-2014
Are you now, or have you ever been, elected or appointed to any public office? ❑ No El Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
City of Okeechobee City Council 2014 1
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? El No ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? ID No ❑ Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part 111, Code of Ethics for Public Officers
and Employees? El No ❑ Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? ID No ❑ Yes, and list:
DATE(S) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. El No ❑ Yes, and list:
JOB TITLE OR COVERED POSITION TrrLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
Worked for the SFWMD for 36 years dealing with water and natural resource issues
Member of the Heartland Career Source Board dealing with workforce in our area
Worked with CFRPC on regional transportation issues
Serve on the Governor's MCORES Toll Road Task Force for the Southwest Central Corridor
Serve on the SFWMD WRAC Committee
Serve on the Loxahatchee River Management Council
Serve on the Indian River Lagoon/NEP Management Board
Serve on the Okeechobee Battlefield Friends Board and helped establish the Park
Assisted in the development of the Lake Okeechobee Scenic Trail
Chair of the Youth Services Council for the Heartland and Okeechobee Area
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: El MALE 0 FEMALE
ETHNIC GROUP: El CAUCASIAN 0 BLACK 0 SPANISH HERITAGE 0 NATIVE AMERICAN
0 ASIAN OR PACIFIC ISLANDER 0 OTHER(specify):
./ALL THAT APPLY: 0 WARTIME PERIOD VETERAN 0 DISABLED VETERAN
0 VIETNAM VETERAN
HANDICAPPED STATUS: ONO 0 YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge
Signature of
of the above statements.
Date: _7-4-d.v
1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: "....membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and II, detention office supervisors, residential officers, residential officer supervisors I and 11,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
Q` QF O372CH055 Southeast 3' Avenue * Okeechobee * Florida * 34974 * (863)763
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APPOINTMENT
Please print or type all information. The information from this application will be used by the City
Council in considering action on your appointment The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "NIA" where appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
0 Planning Board/Board of Adjustment & Appeals/Design Review Board
11 Okeechobee Utility Authority Board of Directors (City Residents Only) RGAdtflf i Pp" &WAY
13 Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
(City Resident Trustee:__Q_ OR Fifth Member Trustee:_Q_)
ID Other: Charter Review Committee
APPLICANT'S FULL NAME:
NAME COMMONLY USED:
RESIDENCE ADDRESS:
HOW LONG AT ADDRESS:
MAILING ADDRESS:
TELEPHONE/CELL:
ARE YOU AN US CITIZEN?
FLORIDA REGISTERED VOTER?
EDUCATION:
POST SECONDARY EDUCATION:
MILITARY SERVICE:
CURRENT OR MOST RECENT EMPLOYER:
JOB TITLE/DESCRIPTION:
WORK ADDRESS:
WORK TELEPHONE:
ARE YOU CURRENTLY EMPLOYED AS:
(CHECKV ALL THAT APPLY)
Myranda McAllister Whirls —
Myranda Whirls
1102 SW 4th Street Okeechobee, FL 34974
Years: 6 Is this in the City Limits? [a Yes 13 No
1102 SW 4th Street Okeechobee, FL 34974
863-697-8579
El Yes 0 No, explain:
El Yes County Registered in: Okeechobee
0 No
Okeechobee High School 2010
IRSC AA 2010-2012
Self Employed / G.M. Worley, Inc.
Accounting Services / Accountant
1102 SW 4th St / 110 NW 5th St
863-417-5395 / 863-467-2541
El General Contractor
0 Engineer
0 Attorney
171 Lay Person
El Business Person
11 Sub -Contractor
0 Doctor
13 Urban Planner
OArchitect
0 Realtor
0 Surveyor
0 Landscape Architect
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? ID No 0 Yes, and list:
AGENCY 90 -ARD NAME POSITION DATES}
Are you now, or have you ever been, elected or appointed to any public office? 0 No 0 Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? El No 0 Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? [I No 0 Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been found to be in violation of Florida Statutes Chapter 112, Part III, Code of Ethics for Public Officers
and Employees? [D No 0 Yes, and list:
DATE(S) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no contest, or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? El No 0 Yes, and list:
DATE(S) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. ID No 0 Yes, and list:
JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to th(
Boardou wish to serve on. Include personal accomplishments that qualify you for the appointment.
ace is needed, please attach an additional page.
I have been an Okeechobee resident for my entire life, have started my own family here, and plan
to continue to be a part of this community. As such, I have an active interest in making our city
the best it can possibly be for residents now and for our future generations.
Experience/Skills:
Accountant for local businesses - 6 years
Accountant for the state of Florida - 2 years
Small business owner - 2 years
Construction industry and permitting experience - 2 years
Former licensed Realtor
Chair of the Rotary of Okeechobee Sunset Club - 1 year
Rotary Club Okeechobee Member - 2 years
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: 0 MALE El FEMALE
ETHNIC GROUP: 0 CAUCASIAN 0 BLACK 0 SPANISH HERITAGE 0 NATIVE AMERICAN
0 ASIAN OR PACIFIC ISLANDER 0 OTHER(specify):
/ALL THAT APPLY: 0 WARTIME PERIOD VETERAN 0 DISABLED VETERAN
0 VIETNAM VETERAN
HANDICAPPED STATUS: El NO 0 YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119,
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: i understand and agree that should 1 be appointed to a citizen
board/committee for the City of Okeechobee, 1 will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that
Signature of Applicant:
of the above statements. t
Date:�7 € r
1. The City Code Book Sec, 70-151, 70-171, 70-19170-211 read: "....membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
reactor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and ii, detention office supervisors, residential officers, residential officer supervisors I and 11,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CiTY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
CiTY CLERKS OFFICE USE ONLY
APPOINTED TO:
CITY COUNCIL
INITIAL TERMPPOINTED TERM RE -APPOINTMENT RESIGNEDIiERM CERTIFICATE OF
MEETING: DATES: NOTIFICATION SENT: SUNSET: APPRECIATION PRESENTED:
CITY OF OKEECHOBEE
55 Southeast 3r Avenue * Okeechobee * Florida * 34974 * (863) 763-3372
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APPOINTMENT
Please print or type all information. The information from this application will be used by the City
Council in considering action on your appointment. The application MUST BE COMPLETED IN
FULL. Answer "None" "Not Applicable" or "N/A" where. appropriate.
CHECK (0) THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARDS DUTIES, MEETING DATES, AND TIMES ARE ATTACHED
❑ Planning Board/Board of Adjustment & Appeals/Design Review Board f rgeff Q}J)
o
13 Okeechobee Utility Authority Board of Directors (city Residents only)
❑ Police Officers Pension, Firefighters Pension, or General Employees' Retirement System Board of Trustees
)
(City Resident Trustee: OR Fifth Member Trustee:111
❑ Other: I.E.AAAA)-r-1 V
APPLICANT'S FULL NAME:
0
NAME COMMONLY USED:
I LEF
RESIDENCE ADDRESS:
HOW LONG AT ADDRESS:
Years: 40 Is this in the City Limits? ❑ Yes 'o
MAILING ADDRESS:
TELEPHONE/CELL:
ARE YOU AN US CITIZEN?
es ❑ No, explain:
FLORIDA REGISTERED VOTER?
es County Registered in:
❑ No
EDUCATION:
High School Name & Location Year Graduated
POST SECONDARY EDUCATION:
College Name(s) Certificate/Degree(s) Awarded Date(s) Attended
MILITARY SERVICE:
Branch(es) Dates of Service Discharge Date
. A k
CURRENT OR MOST RECENT EMPLOYER:
Wbqaw, 141c,
d
JOB TITLE/DESCRIPTION:IZ,
WORK ADDRESS:
110— a.
WORK TELEPHONE:
–
° ARE YOU CURRENTLY EMPLOYED AS:LI-General
Contractor of Business Person ❑ Architect
(CHECK ✓ ALL THAT APPLY)
❑ Engineer ❑ Sub -Contractor ❑ Realtor
❑ Attorney ❑ Doctor ❑ Surveyor
❑ Lay Person ❑ Urban Planner 0 Landscape Architect
Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? ❑ No Wfe-s, and list:
AGENCY BOARD NAME _ POSITION '' DATE(S)
A�Ze
Are you now, or have you ever been, elected or appointed to any public office? 13•No ❑ Yes, and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S)
Do you work with or have any association with a current member of the board/committee to which you are requesting
appointment? U-N'o ❑ Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION
Are you related to, or employed by, any City of Okeechobee employees or elected officials? B'No ❑ Yes, and
list:
NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION
Have you ever been found-to be in violation of Florida Statutes Chapter 112, Part III, Code of Ethics for Public Officers
and Employees? o ❑ Yes, and list:
DATES) NATURE OF VIOLATION
Have you ever been convicted of a FELONY, plead guilty or no con es , or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? ."o ❑ Yes, and list:
DATES) VIOLATION CITY AND STATE
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with
a specific public records exemption can be withheld. In order to claim the exemption complete the following:
Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who
is exempt from pub'(-.:,records disclosure under Florida Statute 119.071? Review list of other covered employees before
responding. 121 No ❑ Yes, and list:
JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
If more space is needed, please attach an additional page.
i -i - i P,
uxj
I-1 tP
d
e.
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL
STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES,
VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE
NO BEARING ON YOUR APPOINTMENT:
SEX: ALE 13 FEMALE
ETHNIC GROUP: AUCASIAN ❑ BLACK ❑ SPANISH HERITAGE ❑ NATIVE AMERICAN
❑ ASIAN OR PACIFIC ISLANDER d OTHER(specify):
./ALL THAT APPLY: ❑ WARTIME PERIOD VETERAN 0 DISABLED VETERAN
❑ VIETNAM VETERAN
HANDICAPPED STATUS: ❑ NO ❑ YES, AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public
record.
CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1 -Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records, records retention, public record requests, and the open public meeting
requirements.
I hereby acknowledge that I have read and undergtand each of the above statements.
Signature of Applicant:
Date: /Zo
1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: ....membership of the board, where possible, shall
consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor,
realtor, business person, and lay persons."
2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers;
juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice:
detention officers I and II, detention office supervisors, residential officers, residential officer supervisors I and II,
counselors and supervisors, human services counselor administrators, senior human services counselor administrators,
rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the
Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose
responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the
Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department;
justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special
magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and
child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public
defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad [item; human resource,
labor relations, or employee relations directors and assistants, managers or assistant managers of any local government
agency or water management district whose duties include hiring and firing employees, labor contract negotiations,
administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see
§119.071, Florida Statues].
PLEASE RETURN COMPLETED APPLICATION TO:
CITY OF OKEECHOBEE
OFFICE OF THE CITY CLERK
55 SE 3RD AVENUE, ROOM 100
OKEECHOBEE, FLORIDA 34974
CITY CLERKS OFFICE USE ONLY
APPOINTED TO:
CITY COUNCIL INITIAL TERM NOTIFICATION RE -APPOINTED TERM RE -APPOINTMENT RESIGNED/TERM CERTIFICATE OF
MEETING: DATES: SENT: DATES: NOTIFICATION SENT: SUNSET: APPRECIATION PRESENTED:
f '