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Referred by: --::c----,---,------
A1ayor or Commissioller
%"~1
CITY OF SOUTH MIAMI BOARD/COMMITTEE APPLICATION
6130 Sunsel Drive
South Miami, FL 33143
Phone No. 305-663-6340
FaxNo. 305-663-6348
1. I am interested in serving on tbe following board(s)/committee(s):
Planning Board
FU"si ~hoi~c SecQnd chol~e
FOllrdl choice
z. Name: Sandra Oi Mnre·Vivllf
(p1.as. print)
Home Address: 6871 Sunset Drive, Southl'vtiatru Fl33143 3.
5. Home Phone No. ~:.-_3_03_-_57_4_9 ____ _ Business Phone No:O S.(-i31.2223
FaxNn. ----------
6. E-mail Addre5~~ndractilnL1r(>@yah(J~1''-'OI1l
7. Edu~ationlDegree Earned: _"""':;;'"ar,,k-::":;;liJ7,g~;;;-______________ _
Pertinent Experience: ___ -'s_"c.-'..;rit._.'_"cc,-'ch_G_'_·o-'''p'__ _____________ _
Field Expertise, ___________ -,-_____________ _
8. Cnmmu.nity Service:
9.
10.
11.
12.
Attached Resume: (Optional)
Are you a registered voter?
Are you a resident of tbe .City?
Do you have a business io the City?
Yes~ Yes
Yes V N°B No
No
Please be aware that all applican.ts who are appoiuted to any City hoard, commission or committee, as well as all
employees and volunteers, who will provIde any service or who may come into contact with vulnerable persons as
defined in Section 435.02, Fla. Slat. (including cltildren altd the elderly) in the course of their appaintmentl
employnrent or volunteeris1t4 musl compliance with Level II Background Screenmg and fingerprinting
requiremmts us per, F1 Statute Ch. 435. Such individu.al must have passed the bacKground screening to the
satisfaction of tlte C' 0 the appointment to the positicJ1J or 'he start of any employment (IT volunteerism.
Signature ___ ~", 02/15/18 Date ________ _
Revised 4115