The City of South San Francisco
Office of the City Clerk
400 Grand Avenue RECD CITY GLERK
South San Francisco, CA 94080 2022 APR 7PN1:38:30
(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 uthority Communit Authority Hotel Committee (BPAC) Representative Representativ Representative Housing
Cultural Arts Equity and Public Housing Authority
Commission Safety Commission Authority Tenant Commission Library Measure W Citizens' Parking Place Parks & Recreation Board J Oversight Committee Commission Commission
Personnel SSF General Plan 2040 Traffic Safety
Planning
Board Community Advisory Commission
Commission
Committee
Youth
Commission
Are you interested in participating in the Citizen's Academy? ( )Yes • No
PERSONAL INFORMATION
Garcia Nancy Del Carmen
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? 21 Have you attended any meetings of the commission/board for which you are applying? Yes No l 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 — No Number of hours employed in South San Francisco:
Housing Authority Tenant Commission
Are you a resident of the Housing Authority? Yes • No O Youth Commission - (Ages 14 to 22)
If not a resident of South San Francisco, are you a student of SSFUSD? Yes No LI 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.
Becuase I want my voice to be hear
Why do you want to be a member of a Board/Commission/Committee? What do you feel you could contribute? I can raise awarense how mental ills people are treat by the police What qualifies you for this appointment? Because I have been fiting for my husband right who is mental ills What is your vision for growth in South San Francisco? I want the police to be training and educating in mental illness Are you currently receiving any form of compensation from the City for work performed? Yes No DI 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 L If yes,
Name Position Relationship
EDUCATION - Please include additional information on separate sheet.
Universidad del Zulia in Venezuela Lic. En Ciencias Sociales Mention Geography 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? 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. 2002 Kilar Family- Donohoue Family Housekeeping
Dates employed Employer Position
Duties
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.
04/06/2022
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