The City of South San Francisco
Office of the City Clerk RECD CITY CLERK
400 Grand Avenue 2021 MAR 18 PM8:32:42
CO
South San Francisco, CA 94080
(650) 877-8518 (fax) (650) 829-6641
CALIFORNIA
Application for Boards and Commissions
APPLYING FOR (more than one may be checked)
Bicycle and Colma Creek Flood Conference Center Conference Center Pedestrian Zone Advisory Authority Business Authority Community Advisory Committee* Representative Representative
Committee
Conference Center Cultural Arts Housing Authority Housing Authority Authority Hotel Commission Tenant Commission
Representative
Library Board Measure W Citizens' Parking Place Parks & Recreation Oversight Committee Commission Commission
Personnel Board Planning Commission San Mateo County Traffic Safety Mosquito And Vector Commission
Control District*
*County Boards and Commissions
Are you interested in participating in the Citizen's Academy? Yes L No
PERSONAL INFORMATION
Burgo, Brittany, Antoinette
Name (last, first, middle)
South San Francisco, CA, 94080
Address (number, street, and apartment number) City, State and Zip Code Telephone number Cell phone/alternative contact number E-mail address How many years have you been a resident of South San Francisco? 18 Have you attended any meetings of the commission/board for which you are applying? Yes No L If yes, which one(s)?
Why are you seeking this appointment? I want to be involved in making decisions and having a bigger impact for the community.
What qualifies you for this appointment? My passion and dedication to the community My direct work with the community provides me the opportunity to represent the unheard voices.
Additional information/qualifications that support your application:
Are you currently receiving any form of compensation from the City for work performed? Yes No If yes, please explain:
Do you have any relatives serving on Council, Commissions, Boards, and Committees or otherwise employed by the City of South San Francisco? Yes No If yes,
Name Position Relationship
For official use only Accepted Not Accepted Initials Date EDUCATION - Please include additional information on separate sheet.
Skyline College
Name and location of college/university/technical or trade school Dates attended A.A in Administration of Justice Spring 2017
Major subjects Degrees received
Cal State East Bay
Name and location of college/university/technical or trade school Dates attended B.A in Human Development Fall 2021
Major subjects Degrees received
CIVIC ACTIVITIES, CLUBS, ASSOCIATIONS - Please include additional information on separate sheet.
Hothra/Friends of Old Town 2014-Present
MISCELLANEOUS - Please include additional information on separate sheet or attach resume.
Military Service: Dates and branch CA driver's license number WORK EXPERIENCE - Please include additional information on separate sheet or attach resume.
Aug 2011-June 2020 Boys & Girls Clubs of North SMC Director Dates employed Employer Position
Providing enrichment programs to children while maintaining a positive safe environment Aug 2020-Present The Carey School Asst. Director
Dates employed Employer Position
Assisting teachers and running the afterschool program
Duties
I certify that, to the best of my knowledge, all statements in this application are complete and true. I agree and understand that any mis- statement of material fact will cause me to forfeit all rights to appointment to a Commission, Board, or Committee with the City of South 3/17/21
Signature Date
The interest of the City is served best by actual and regular participation by Board and Commission members. Thus, upon the second absence from a regular meeting within any rolling twelve-month period, a member shall receive a written communication from the Mayor requesting that the member respond to the Mayor with an explanation for said absences within one week of the member's receipt of the written communication. The Mayor shall report to the City Council the reasons provided for the member's absences. If the City Council determines that the absences occurred for legitimate reasons, the City Council may excuse both or one of the absences. Members are also encouraged to give advanced notice of their absence from meetings.
Applications are accepted on a continuous basis and will remain valid 1 year from the date of submission. If you are selected to serve on a Board or Commission, you may be required to file an Annual Statement of Economic Interest (FPPC Form 700).
PRINT AND MAIL TO:
CITY OF SOUTH SAN FRANCISCO
Office of the City Clerk
400 Grand Avenue, South San Francisco, CA 94080
For more information, call (650) 877-8518
Trouble submitting? Sign, save, attach and
email to: [email protected]