SOUTH SAN BE The City of South San Francisco
Office of the City Clerk
cn
400 Grand Avenue
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 Conference Center Conference Center Conference Center Pedestrian Advisory Authority Business Authority Community Authority Hotel Committee (BPAC) Representative Representative Representative Cultural Arts Housing
Equity and Public Housing Authority
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
JUNIO Arnel Gutierrez
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 mimic inter Here key done te tin wil your fis choice
How many years have you been a resident of South San Francisco? 27 Have you attended any meetings of the commission/board for which you are applying? Yes L NO VI If yes, which one(s)?
BPAC
Are you a resident of South San Francisco? Yes No D
If no, are you employed in South San Francisco? Yes INO D Number of hours employed in South San Francisco:
Housing Authority Tenant Commission
Are you a resident of the Housing Authority? Yes No •
Youth Commission - (Ages 14 to 22)
If not a resident of South San Francisco, are you a student of SSFUSD? Yes No D Current school:
Conference Center Authority Hotel Representative
Which hotel within the City of South San Francisco are you representing? 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 want an active role in shaping my community. My work experiences provide a good foundation.
What qualies you for this appointmen? I am employed by the state (CA) that helps protect public welfare.
What is your vision for growth in South San Francisco? I predict the city will continue to attraet employers (big&, small), which will result in more housing and infrastructure needs.
Are vou currently receiving any form of compensation from the City for work performed? Yes NO D 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
EDUCATION - Please include additional information on separate sheet.
Skyline College (then transferred to CSV-Hayward) * did not finish Name and location of college/university/technical or trade school Degrees received 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? I am a former Parks é Recreation Commissioner (SSF).
I am a former coach for the Paifica Girls Softball League.
MISCELLANEOUS - Please include additional information on separate sheet or attach resume. 1986 to 1994: USAF (Honorably Discharged)
Military Service: Dates and branch
WORK EXPERIENCE - Please include additional information on separate sheet or attach resume.
Licensing,
01-01-2014 to Present (CA) Dept. at Alcoholic Beverage Control. Representative II Position
Investigate into person(s) and premises fur suitability of retail/ non-retail liquor license. 12-0-2009 to 12-31-2013 (CA) Employment Dodopment Dept. Program Representative Provide job search assistance to eligible Veterans. Serve as a liaison between Duties
prospective employers and job seekers.
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.
4/8/2022
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)
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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
For official use only Accepted Not Accepted Initials Date