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Office of the Governor United States Virgin Islands PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE YOU COMPLETE THIS QUESTIONNAIRE. 1) 2) 3) 4) 5) ALL questions must be fully and correctly answered and returned to the Office of Legal Counsel! within seven (7) business days of your receipt of the Questionnaire. Do not submit a resume instead of this Questionnaire. If more than the allotted space on this form is required for a complete and full answer, please attach as many additional 8% x 11 sheets as may be needed. At the top of each additional sheet put your name, "Office of the Governor, Office of Legal Counsel", and then reference the question number before each answer. The Questionnaire is in PDF Format. Please complete all responses clearly in black font color. Responses are NOT to be handwritten. Please do not hesitate to call the Office of Legal Counsel at Government House at (340) 774-0001 if you have any questions concerning this Questionnaire. stethoscopes eaaaaaa_socchlc _ss sftmo df d F o oftootco ooem settoggame oh ccomogffffgfoo a mooos o oooeotsd def.cat Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 3|Page NOMINEE’S NAME; 10. EMPLOYMENT RECORD: Please list, in chronological order, your complete employment record for the past ten (10) years, beginning with the present or most recent position. {Attach additional sheet(s), if necessary, and reference this question number] Employer Dates of Position Address/Phone # Supervisor Employment pa mart 2006 - Present | Certified Res. None Elizabet Real Estate Guadalupe-Perez Appraiser 11. GOVERNMENT EXPERIENCE: A. List all federal, state, territorial or focal government services, giving dates and type of service such as employee, boards, commissions, executive, legislative or judicial branches, consultant, voluntary service, part-time or honorary. [Attach additional sheet(s), if necessary, and reference this question number] 8. List and attach a copy of all service contracts you have held independently or been a party to with the Government of the Virgin Islands. N/A Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 4|Page NOMINEE’S NAME: 12. BUSINESSES AND FINANCIAL INTEREST: List all businesses (for profit or not for profit), real estate and trusts in which you have at least a 10% interest or control of assets or serve as an officer or member of a board with voting rights. [Attach additional sheet(s), if necessary, and reference this question number] N/A 13. QUALIFICATIONS: What in your opinion qualifies you to serve the People of the Virgin tslands in the position which the Governor has nominated you? I'm committed. | enjoy mentoring and sharing my knowledge with others. | have strong ethics and | dedicate to always put forth my best efforts in anything | have to do. | have developed strong leadership skills throughout my career and as a minister which | can apply to serve the People of the Virgin Islands. SECTION Il: HONORS AND ACCOMPLISHMENTS 14. MEMBERSHIPS: List all memberships and offices held in professional, fraternal, scholarly, civic, charitable, and other organizations. Co-Pastor/Missionary - La Iglesia de Dios de Santa Cruz, Inc. 15. BOARDS, COMMISSIONS, TRUSTS, ETC.: List all government or private sector boards, trusts, or fiduciary responsible positions on which you have served or are now serving. N/A 16. HONORS AND AWARDS: List all scholarships, fellowships, honorary degrees, honor society memberships, and any other special recognition for outstanding service or achievement. Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions S|Page NOMINEE’S NAME: N/A 17, PUBLISHED WRITINGS: List all titles, publishers and dates of books, articles, reports, or other published materials you have written. N/A 18. SECTION ill: CHARACTER Have you ever been the subject of a grand jury, police, and department of justice or any legally constituted government authority, investigation anywhere or at anytime? __YES X_NO if your answer is yes, please explain with details including date and location. [Attach additional sheet(s), if necessary, and reference this question number] 19. Have you ever been arrested in any geographical location for any offense, including traffic violations? YES * NO If yes, please explain with details including offense, date of location and disposition. [Attach additional sheet(s), if necessary, and reference this question number] Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 6| Page NOMINEER’S NAME: 20. Have you ever been convicted of a felony ora misdemeanor? _ YES X NO If yes, please explain with details including offense, date, location, and current status. [Attach additional sheet(s), if necessary, and reference this question number] 21. _—Is there now or has there ever been a judgment entered against your _ YES % NO if the answer is yes, please explain with details on date, location and disposition or current status. [Attach additional sheet{s), if necessary, and reference this question number) 22. Have you ever been a respondent in any labor dispute or discrimination proceeding? ___YES X __NO If the answer is yes, please explain with details on date, location and disposition or current status. [Attach additional sheet(s), if necessary, and reference this question number] 23. Have you ever been named as a party in any hearing, administrative, civil, and criminal, including Equal Employment Opportunity or sexual harassment? _ YES xX NO If yes, please explain in detail, giving date, venue, agency, and the names of the other parties and the disposition. [Attach additional sheet(s), if necessary, and reference this question number] Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 7|Page NOMINEE’S NAME: 24. Have you now or have you ever been a member of an organization or an associate of an individual advocating terrorism, overthrow of a government by force or the advocacy or subordination of any ethnic group or individuals? | YES X* NO \f the answer is yes, please give details of dates, names of organizations, names of individuals and all pertinent circumstances. [Attach additional sheet(s), if necessary, and reference this question number] 25. Do you know of any individual, organization or group, which can be expected to oppose your nomination? | YES X_ NO if the answer is yes, please list the individuals, organizations or groups by name and give the details of your belief for their opposition. [Attach additional sheet(s), if necessary, and reference this question number] -4 26. Do you have any outstanding and delinquent monetary obligations to the Government of the Virgin Islands or any other public or private entity, including but not limited to, personal income taxes, business taxes, real property taxes (commercial or residential}, business license renewals, trade name renewals, annual reporting fees, professiona! organization dues, child support, judgments, debt Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 8|Page NOMINEE’S NAME: Government of the Virgin Islands, includes but is not limited to the following departments, agencies and instrumentalities: the Bureau of Internal Revenue, Tax Assessor, Department of Justice Division of Paternity and Child Support, Board of Education, Economic Development Authority, U. S. Small Business Administration, Small Business Development Center, Police Department, Department of Licensing and Consumer Affairs, the Water and Power Authority, the Waste Management Authority, Department of Health, Department of Human Services YES x NO If the answer is yes, please attach a detailed explanation of what outstanding and delinquent monetary obligations are owed, the reason for the delinquency, and the intended plan to bring the matter current. SECTION IV: CONFLICT OF INTEREST 27. Please explain your understanding of "Conflict of Interest" as it applies to the position to which you have been nominated to serve the People of the Virgin Islands. Conflict of Interest is when an individual chooses personal interest gain over the duties to an organization or responsibilities. 28. Do you own a business or real estate, or are you a partner or shareholder or affiliated in any way to sell or provide goods or services to the Virgin Islands Government? YES *X_NO if the answer is yes, please explain and give the name and location of these interest(s) and how you promise to remove yourself from any possible conflict. {Attach additional sheet(s}, if necessary, and reference this question number] ee + - ~ — Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 9|Page NOMINEE’S NAME: 29. Does any close relative or spouse have a business or real estate interest(s) as described in question 25? = CYES) = X_ ONO \f the answer is yes, please explain and give the name and location of these interest(s) and how you propose to remove yourself from any possible conflict. (Attach additional sheet(s), if necessary.) SECTION V: JOB PERFORMANCE 30. Inno more than 150 words, please outline in priority order your four (4) specific short-term and four (4) specific long-term goals and objectives you would employ to achieve the entity's purpose and improve its service delivery system if your nomination is confirmed for this position. Short-term goals | will commit time and make myself available to the board. 1 will eam the rules and regulations to follow. | will anhance my professional skills by completing any required course | will assist in any pending project. |Long-term goals | will apply and commit with my short-term goals to achieve the purpose, vision, and purpose of this entity. ~ 31. Is there any additional information that you believe would assist the Committee on Rules and the Judiciary in processing your nomination expeditiously? Office of the Governor Questionnaire for Nominees to Departments, Agencies, Boards & Commissions 10|Page NOMINEE’S NAME: CERTIFICATION: This is to certify and affirm that all the statements contained herein and in any supporting documents or schedules or other such supporting documents or schedules executed at a later date as a part or addendum to this document are true and correct to the best of my knowledge and are made in good faith. Signed this_\2— _dayof__\\ 2024 Elizabeth Guadalupe-Perez Ske eZ zs » - biel = Nominee’s Name [Print Clearly] Signature of Nominee C Sworn and subscribed before me this | o- day of K ae ar 20244 Notary Pyblic of the US. Virgin islands [seal] My commission expires: cf lyon St B. WILTON Notary Public St. Crow, U.S, Virgin Istands NP-§54-22 My Commission Expires October 11, 2026