The City of South San Francisco
Office of the City Clerk
400 Grand Avenue
South San Francisco, CA 94080
(650) 877-8518 (fax) (650) 829-6641
CALIFOR
Application for Boards and Commissions
APPLYING FOR (more than one may be checked)
Bicycle and Colma Creek Flood onference Center onference 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 SSP General Plan Mosquito And Vector 2040 Community
Control District* Advisory Committee
Traffic Safety Youth Commission
Commission
*Counry Boards and Commissions
Are you interested in participating in the Citizen's Academy? Yes [NO- (alreasly participate
PERSONAL INFORMATION
maharas Reena
South San Francisco CA 94080
ddress (numher street and anartment number) City, State and Zip Code Samk
Telephone number Cell phone/alternative contact number E-mail address If you selected more than one Board/Commission/Gommittee of interest, please rank your preferences here, starting with your first choice Conference center
How many years have you been a resident of South San Francisco 2 322 plus Have you attended any meetings of the commission/board for which you are applying? yes ID No. anterena enter autunity community Rep
If yes, which one(s)?
BPAC
Are you a resident of South San Francisco? Yes
If no, are you employed in South San Francisco? Yes
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 INoD Current school:
Conference Center Authority Hotel Representative A /A
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?
Chick 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 haue uned, years ty femi
What qualifies you for this appointment? eining here and empoyment
What is your vision for growth in South San Francisco? To Seel and Serve our city grow and framish:
Are you currentiy receiving any form of compensation from the City for work performed? Yes If yes, please explain: NIA
Do you have any relatives serving on Council, Commissions, Boards, and Committees or otherwise employed by the City of South San Francisco? Yes Zubin Maharaj Husband
Position Relationship
EDUCATION - Please include additional information on separate sheet.
Unmersitu Notre Dane Phoetrix BA% MBA (Business
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? Volunteer opportunities.
MISCELLANEOUS - Please inclsde additional information on separate sheei or attach reseme.
NIA
Military Service: Dates and branch
WORK EXPERIENCE - Please include additional information on separate sheet or attach resuuse.
Dep 20l0 to present Millopeninsula medical aB Dineto
Position
Sam 2003 to Sep 2010 Menage and ourse mano operans.
Man 2003 to sep 200 Genentech Inc. Contract Analyst:
Dates employed
me and press client nebeste and payment.
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
March 9,2020
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
Office of the City Clerk
400 Grand Avenue, South San Francisco, CA 94080
For more information, call (650) 877-8518
Recoved oN
For official use only Accepted Not Accepted Initials | Date 319.22