Dodaro, Nicholas CEB & CDB 1-31-2005 v •
CITY OF ATLANTIC BEACH
BOARD/COMMITTEE MEMBER APPLICATION FORM
Please check(v)beside each Board or Committee that you are applying to serve on:
(A summary of each board/committee is available on page 2 of this form.)
X Code Enforcement Board Q Community Development Board
Pension Board of Trustees 7 Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: N taHo t.A S t1.
ADDRESS: 33'3 (-2..-Ch ST•
DAYTIME PHONE: ciCR 2-4q--43t-IQ EVENING PHONE:
E-MAIL ADDRESS: brIckorkaflo€Ino6ct%I.O,DM FAX: SOLk VAR-43t-(°l
Please explain any employment experience,board/committee experience,and/or community volunteer
experience relative to the board/committee applying for.
I believe I have the knowledge and experience base to assist in many issues relating to either the Code Enforcement
Board or the Community Development Board. First, I am a Board Certified Emergency Medicine physician.
trained here in Jacksonville. As such. I will be comfortable relating to issues of the Florida State Health Code. My
camaraderie with many of the current leaders in the medical community may also benefit our efforts here in
Atlantic Beach. Additionally. I was the founder (and CEO) of a small real estate investment and development
company in Myrtle Beach. SC. From this experience I have gained a modest appreciation and understanding of
housing and building codes.zoning issues,and the like. Finally, I have been chairperson of several committees in
large hospitals,giving me experience in the challenges of leadership and successful navigation of complex issues
involving diverse groups of people. I would be happy to elaborate on the details of these experiences and how they
may allow me to effectively serve the community of Atlantic Beach.
Please provide a brief explanation of your interest or any special qualifications you have in this field and
your reasons for wishing to be appointed to this board/committee.
My interest in serving on one of these committees stems from my appreciation of the Atlantic Beach community
and a desire to be involved in that (my) community. For me. long-term commitment to a place, or a job, or a
hospital, is born from involvement. In that way, I become a part of it's present and it's future. My special
qualifications include:(1)my medical background,providing technical,scientific,and practical knowledge;(2)my
familiarity with hard work, long hours, and commitment; (3) my ability to work with all walks of people. from
CEO's to laborers, smoothly, (4)my understanding of business. finance, and commerce obtained from my family
and developed in my"non-medical"endeavors:(5)my flexible schedule that affords me many days off during the
"work week"to help complete the work of the Board.meet with contacts,etc. I feel that I have a lot to offer either
of these Boards and to the leaders of our community. I wish, truly,to participate in the work of keeping Atlantic -
Beach such a great place to live. Thank you.
rttaLle return comptetru tofu to
Donna L.Bussey,City Clerk, 800 Seminole Road,Atlantic Beach,FL 32233
1
January 31.2005
Donna L.Busses
City Clerk
800 Seminole Rd. •
Atlantic Beach.FL 32233
Re: Board Member Application
Ms. Bussey.
Bello. I hope this letter finds you doing well. I have enclosed a completed application for Board
membership in Atlantic Beach. I have also enclosed a copy of my Curriculum Vitae(R sunk-)for
further details if needed. If you have any questions at all.please don't hesitate to contact me at
any of the numbers listed below.
I look fbnyard to hearing from you.
Respectfully.
Nicholas R. Dodaro.MD.FACEP
373 Twelfth St.
Atlantic Beach.FL 32233
904-2494349(home)
843-260-4750(cell)
ndodaro(a hotmail_com
Chairperson: Pharmacy and Therapeutics Committee(McLeod--2004).
Chairperson: Design and implementation of new written ED chart(McLeod--2003).
Director: Scheduling Committee(Shands Jacksonville-1999).
Director Lecture Information Services(Tulane University 1995).
Participation:
Member: Physician Leadership Committee for the Emergency Dept(McLeod).
Member: Chest Pain Center Development&Implementation Team(McLeod).
Member: Chest Pain Observation Center Committee(McLeod)
Member: Hospital Vision and Mission Statement Development Committee(McLeod).
Member: Hospital Computerized Provider Order Entry Committee(McLeod).
ruff
1/31/2005