The City of South San Francisco
Office of the City Clerk
CITY 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 Housing Housing Authority
Cultural Arts Equity and Public
Commission Safety Commission Authority Tenant Commission Library Measure W Citizens' Parking Place Parks & Recreation Board Oversight Committee Commission Commission
SSF General Plan 2040 Traffic Safety
Personnel Planning
Board Commission Community Advisory Commission
Committee
Youth
Commission
Are you interested in participating in the Citizen's Academy? ( Yes No I do not know what The Citizen's Academy is
PERSONAL INFORMATION
Flores, Jasmin Torres
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 If you selected more than one Board/Commission/Committee of interest, please rank your preferences here, starting with your first choice.
How many years have you been a resident of South San Francisco? 30 Have you attended any meetings of the commission/board for which you are applying? Yes WI No V If yes, which one(s)? No, because it is a newly formed Commission BPAC
Are you a resident of South San Francisco? Yes
If no, are you employed in South San Francisco? No M
Number of hours employed in South San Francisco:
N/A
Housing Authority Tenant Commission
Are you a resident of the Housing Authority? Yes
Youth Commission - (Ages 14 to 22)
IF not a resident of South San Francisco, are you a student of SSFUSD? Yes I No V Current school:
Conference Center Authority Hotel Representative
Which hotel within the City of South San Francisco are you representing? N/A Sa one real Man 2040 Community Adian Commits N/A 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? Committed to equity, social justice, and public safety, I can contribute trustworthines, competence, credentials, and reliability to progress the community.
What qualifies vou for this appointmeng Currently engaged in a Mental Health Ministry, I am hands-on, compassionate, and productive.
What is your vision for growth in South San Francisco? Through a multicultural perspective, I envision rapport, collaboration, and partnership with fellow SSF residents as well as with those in positions of leadership.
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 I No If yes,
Name Position Relationship
EDUCATION - Please include additional information on separate sheet.
School of Public Health, UC Berkeley: Doctor of Public Health; Master's in Public Health Name and location of college/university/technical or trade school Degrees received Stanford Medical School: Primary Care Associate
CA State University, San Francisco: Master's in Rehabilitation Counseling Name and location of college/university/technical or trade school Degrees received University of California, Davis: Bachelor's in Human Behavioral Biology What community activities are you presently involved in, or have been in the past? Now: All Souls Mental Health Ministry; San Francisco Archdiocese Mental Health Ministry Leaders Network. Then: SSF Swim Team.
MISCELLANEOUS - Please include additional information on separate sheet or attach resume.
Military Service: Dates and branch
WORK EXPERIENCE - Please include additional information on separate sheet or attach resume. 2019-Present: Independent Contractor/Consultant
Employer Position
Dates employed
Clinical Liaison for families and patients with terminal illness Duties
1999-2019: Medical Science Liaison in the Biotech/Pharmeceutical Industry with a variety of companies Employer Position
Dates employed
Clinical, educational, medical, and scientific resource for internal and external stakeholders; product launches; relationship-building with Key Opinion Leaders 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.
30 March 2022
Thank You!
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 Not Accepted Initials Date
Accepted