The City of South San Francisco
Office of the City Clerk
400 Grand Avenue RECD GITY CLERK
8 South San Francisco, CA 94080 2022 APR 8 PK2:50:38
(650) 877-8518 (fax) (650) 829-6641
CALIFORNIA
Application for Boards and Commissions
APPLYING FOR (more than one may be checked)
Bicycle and Conference Center Conference Center Conference Center Pedestrian Advisory Authority Business Authority Community Authority Hotel Committee (BPAC) Representative Representative Representative Cultural Arts• Housing Housing Authority
Equity and Public
Commission Safety Commission Authority Tenant Commission Library Measure W Citizens' Parking Place Parks & Recreation Board Oversight Committee Commission Commission
Personnel Planning SSF General Plan 2040 Traffic Safety Board Commission Community Advisory Commission
Committee
Youth
Commission
Are you interested in participating in the Citizen's Academy? Yes No
PERSONAL INFORMATION
FLORES HERNANDEZ, MAURICIO ANTONIO
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 Authority Tenant race
ssien. 5./ Equity
How many years have you been a resident of South San Francisco? I Jo. ISF General Plan Have you attended any meetings of the commission/board for which you are applying? Yes No X If yes, which one(s)?
ВРАС
Are you a resident of South San Francisco? Yes П
If no, are you employed in South San Francisco? Yes I No DI Number of hours employed in South San Francisco:
Housing Authority Tenant Commission
Are you a resident of the Housing Authority? Yes X _ No D Youth Commission - (Ages 14 to 22)
If not a resident of South San Francisco, are you a student of SSFUSD? Yes _ Current school:
Conference Center Authority Hotel Representative
Which hotel within the City of South San Francisco are you representing?. NA South San Francisco General Plan 2040 Community Advisory Committee What is your District of Residency?
Click here to locate your District.
Why do you want to be a member of a Board/ Commission/Committee What do you feel you could contribute? I would like -serve d."
experience - LOVE THIS CITY
What is your vision for growth in South San Francisco?
I Would like to see the bestrale cranent in the different areas. I Want a kigo Are you curely teceiving any form of compensation from the city for work perimeters If yes, please explain: _ NA
Do you have any relatives serving on Council, Commissions, Boards, and Committees or otherwise employed by the City of South San Francisco? Yes No L If yes,
Name Position Relationship
EDUCATION - Please include additional information on separate sheet.
UNIVERSIT DE CANENTED, BERKELEY, CA, VIN
Name and location of college/university/technical or trade/school Degrees received candiante AA, AS.
Name and location of college/university/technical or trade school Degrees received What community activities are you presently involved in, or have been in the past? AS-S-C. 3 I buns, electea Skuline lllege tweresident Assolate Students ot Skyline Clere with over 5341 a stents voting for me I Was Few years ago and I Pisticipate in MISCELLANEOUS - Please include additional infarmation on separate sheet or arrach resume. Beards 8 bosmission- Additionaly NA Francisco, ett.
Military Service: Dates and branch
FoH;
WORK EXPERIENCE - Please include additional information on separate sheet or attach resume Sto14 December Zze TENDER GREEN FRONT OF THE HoUSE.
Dates employed Employer
I war performble to Hast cutes twing emers dements father dates assigned by Employer.
Dates employed Employer Position
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 San Francisco.
04-08-2022
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) and bi-annual Ethics Training (AB1234).
PRINT AND MAIL TO:
CITY OF SOUTH SAN FRANCISCO
00 Grand Avenue, of the anty cancisco, CA 9408
or more information, call (650) 877-851
For official use only Accepted Not Accepted Initials Date