Board/Committee Applications v •
CITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION FORM
Please check(4)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.)
ott.
Code Enforcement Board 1° e A Community Development Board I-
-_,-, Pension Board of Trustees 2 Tree Conservation Board
Z Cultural Arts and Recreation Advisory Committee 34'
APPLICANT'S NAME: ;Pa,
ADDRESS: 263 f2 ,F071---4-/C./ /1-- •
DAYTIME PHONE: o 'l 1 .73 7 2 EVENING PHONE: 5100-0 •-'?
E-MAIL ADDRESS: ,Pir,,Dini4-4.e(44-reles/A4CX:
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Please explain any employment experience,board/committee experience,and/or community volunteer
experience relative to the board/committee applying for.
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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.
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Please return completed form to
Donna L. Bussey,City Clerk, 800 Seminole Road,Atlantic Beach,FL 32233
RECEIVED
1
JUL 07 2005
OFFICE OF THE an.CLERK
RAYMOND D. MARTIN,JR.
2263 Barefoot Trace Phone 904-241-3372
Atlantic Beach, FL 32233 Fax 904-246-7889
Employment History:
January, 2000-January,2002
JEA/Oasis Staffini!
Real Estate Specialist
Responsibilities include site selection,performance of due diligence activities together
with acquisition and closing responsibilities related to real estate services. I also perform
document review, respond to customer inquiries and other duties as assigned.
January, 1996-October, 1999
Lawyers Title Insurance Corporation
Assistant Vice President -Account Executive
I was responsible for the development and maintenance of agency accounts in the
Jacksonville Market. Received an award as the outstanding sales achiever for Lawyers
Title in Florida for 1998.
From 1996 to July of 1997 I was also for responsible for the administration of the
Jacksonville production center. Duties in that role included planning and administration
of a title production center-serving agents in the North Florida market.
April, 1991 -January, 1996
Chicago Title Insurance Company
Assistant Vice President -Branch Manager
Manager of a branch office of over thirty employees. Duties included development of
financial and business plans and administration of all aspects of branch operations.
July, 1989-April, 1991
First Title and Abstract of the Florida Keys, Inc.
President and Co-Owner
Negotiated purchase of company, from the RTC Developed and implemented systems to
provide title services through the Florida Keys. Developed both business and market
plans for company. Administered operations.
Januar). 1980 - June. 1989
Title Insurance Company of Minnesota
Senior Vice President - Southeast Regional Manager
Total profit and loss responsibility for title insurance, underwriting and claims
management in the regional office,three direct operations and three state agency offices
servicing the states of Florida, Georgia, South Carolina, North Carolina, Virginia,
Washington D.C.,Maryland,Tennessee and Kentucky. Developed a detailed and cost-
effective"Claims Management Program"to significantly reduce agency generated
underwriting claims.
Industry Recognition:
Lawyer's Title Outstanding Sales Achievement Award 1998
President of the Florida Land Title Association(FLTA) 1986-1987
Chairman of the FLTA Political Action Committee 1985
ALTA Educational Committee Member 1987-1988
Education:
Robert E. Lee High School Jacksonville University
Jacksonville,Florida Jacksonville,Florida
High School Diploma- 1960 1961-1963
Majors:Government and Histoty
Have completed numerous sales,computer,and management courses, including
The American Management Association's Business Management series at the
University of North Florida and the nationally recognized three-month course at
Management Skill Development Center in Minneapolis.
References furnished upon request.
CITY OF ATLANTIC BEACH
BOARD/COMMITTEE MEMBER APPLICATION FORM
Please check(\I)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.)
/Code Enforcement Board Community Development Board
Pension Board of Trustees 0 Tree Conservation Board
73 Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: J Lif if i- i G 1 S f
ADDRESS: 114,3 j0Akx 1E121 L' t iic i l9rJ eC H
DAYTIME PHONE: L - $;Z.1 EVENING PHONE: Lig- 91 S''.3
E-MAIL ADDRESS: FAX:
Please explain any employment experience.board/committee experience,and/or community volunteer
experience relative to the board/committee applying for.
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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.
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Please return completed form to
Donna L. Bussey,City Clerk,800 Seminole Road,Atlantic Beach,FL 32233
I
. -
CITY OF ATLANTIC BEACH
BOARD/COMMITTEE MEMBER APPLICATION FORM
Please check(N) beside each Board or Committee that you are applyine to serve on.
(A summary of each boardCommittee is available on page 2 of this form.)
v(,,Code Enforcement Board . Community Development Board
V Pension Board of Trustees Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANTS NAME: oSkii.A.c., flitirtlifvult
ADDRESS: 5(0'1 ifttta.
DAYTINIE PHONE: a/6'4-35/-40S-ei EVENING PHONE: g644- Z.-?*0
E-MAIL ADDRESS: pv,f"-•er (41^ trAiit-4.0- FAX:
Please explain any employment experience, boardlcommittee experience, and/or community volunteer
experience relative to the board/committee applying for ,
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Please provide a brief explanation of your interest or any special qualifications you ha‘e in this field and
your reasot s for wishing to be appointed to this boardicommittee.
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Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road,Atlantic Beach. FL 32233
r..
R CFi `ED
FE 0 405
January 31,2005
OFT CLCFTEEan'CLERK
Donna L.Bussey
City Clerk
800 Seminole Rd.
Atlantic Beach,FL 32233
Re:Board Member Application
Ms.Bussey,
Hello. 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(Resume)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 forward to hearing from you.
Respectfully,
Nicholas R.Dodaro,MD.FACEP
373 Twelfth St.
Atlantic Beach,FL 32233
904-249-4349(home)
843-260-4750(cell)
ndodaro@hotmat7.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).
I oft
1/31/2005
A
CITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION FORM
Please check (N) 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 SZ Community Development Board
Pension Board of Trustees 7 Tree Conservation Board
C Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: 1\1 tat-kc t.A 5 P.•
ADDRESS: (-_Th Sr.
DAYTIME PHONE: Ciak-23-ict 3t-ig EVENING PHONE:
E-MAIL ADDRESS: nAcacvro€lelcr6Act% •U)' FAX: SU-k 2AS 43Lic\
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.
M.
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:(I)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.
r Mast return eompleteu 101111
Donna L. Bussey,City Clerk. 800 Seminole Road, Atlantic Beach, FL 32233
RECEIVED
DEC I 22005
CITY OF ATLANTIC BEACH
BOARD l COMMITTEE MEMBER APPLICATION .FORM_ CLERK
Please check(1')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.)
V Code Enforcement Board Community Development Board
Pension Board of Trustees L Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: dig/r g r 1. ^1 1, i S
ADDRESS: 2 32 4) /4-1?-ie Cczy,57 RAce
DAYTIME PHONE: 2tf F.V-E#I i&--PONt: :dr/'1-- 2CG'
E-MAIL ADDRESS:c..tryts f re ev,,.,(, n,4 FAX:
Please explain any employment experience,board/committee experience, and/or community volunteer
experience relative to the board/committee applying for.
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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.
/.kms )PSe.p Ari B. ref DA •t,g- e& f'
Please return completed form to
Donna L. Bussey,City Clerk, 800 Seminole Road,Atlantic Beach,FL 32233
08/14/06 12:05 FAX 9042493202
cvi3 Z002
Veda L. Bernstein
680 Sailfish Drive
Atlantic Beach, FL.32233
904-2424159 Home 904-610-5927 Cell
August 14, 2006
City of Atlantic Beach
Board/Committee Member Application Form
Response to Questions on Application:
I have been privileged to be a resident of Atlantic Beach since 1992. I have
worked at the beaches for as many years. I graduated from Jacksonville
University in 2003 with a Bachelors of General Studies, Cum Laud. My
employment history has been steeped in business administration and accounting.
My ability to focus on details, as well as the long term residual effects of
decisions made today, would be a welcome addition to the Code Enforcement
Board. I look forward to a challenging and rewarding commitment working for
the residents of Atlantic Beach.
As Head of Household and a single parent my volunteer experience has been
limited as I spent my time working full time and giving my daughter a secure,
safe and loving home. At this time my daughter is a sophomore at Stanton
College Preparatory High School, and as she will tell you, it is time for me to"get
a life." I would like to spend my free time heaping my community become
recognized as a model for other communities. I live in the"Royal Palms"
neighborhood and I anticipate a lot of changes in ownership in the up coming
years. We have in place a wonderful mix of residential and commercial land use
and I would like to keep that balance and hopefully ensure that my daughter and
other future residents of Atlantic Beach feel the same way.
I look forward to the opportunity to give back to my community.
ft
,m/i 4TUb 12- 05 FAX 9042493292 CDB
CITY OF ATLANTIC BEACH
BOARD/COMMITTEE MEMBER APPLICATION FORM
Please check(J)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 Ll Community Development Board
0 Pension Board of Trustees 0 Tree Conservation Board
O Cultural Arts and Recreation Advisory Committee
APPLICANT'S NARK: _ Ltd L atttk{►/t4 _ ____-
ADDRESS: tri 4O • wt• A {fl44k +» k a3.1433
DAYTIME PHONE: `i0 GAO 51 EVENING PHONE: ;t44
E-MAIL ADDRESS: NKSJ a & .cQi11 FAX: �.
Please explain any employment experience,board/committee experience,and/or community volunteer
experience relative to the board/committee applying for.
31
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.
. f , t . - f
•s�
Please return completed form to
Donna L.Bussey,City Clerk,800 Seminole Road,Atlantic Beach,FL 32233
I