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? What qualifies you for this appointment?
What is your vision for growth in South San Francisco? ___________________________________________________________________ ________________________________________________________________________________________________________________ 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 No If yes,
Name Position Relationship
EDUCATION - Please include additional information on separate sheet. ________________________________________________________________________________________________________________ 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. ________________________________________________________________________________________________________________ Dates employed Employer Position
________________________________________________________________________________________________________________ Duties
________________________________________________________________________________________________________________ Dates employed Employer Position
________________________________________________________________________________________________________________ Duties
I want to be a member of the YAC because I want to be involved in present projects in SSF; I also want to learn more about how this city operates as well as the opportunies that can be presented to the youth. I would contribute my ideas and opinions on how to better our community, as well as voice problems that the youth may experience. I have served a term on the SSF Youth Advisory Commision this past year, and was apart of this council before t became official as well. I also have experience in leadership and outreach roles/pos tions. My vision for growth in SSF is to provide youth with knowledge/resources that could serve as a foundation for their future. I want the youth to be able to create change within this city, to be able to improve any outdated systems, and to create and have access to wonderful opportunities that could benefit their physical, mental, emotional, and academic goals. We recieve a stipend of $100 per meeting in the Youth Advisory Commission. N/A, currently a high school student in the 11th grade attending El Camino High School. I have been involved with the Youth Advisory Commision this past year as I have served as a commissioner, and was a council member the previous year before it became a commission. I am also one of the social media managers for the Interact/Rotary District Council for District 5150. N/A Sept 2021- July 2022 The City of SSF Youth Advisory Commissioner To attend meetings and voice opinions about current projects and ideas, and how it could benefit the youth. N/A N/A ✔ ✔
I certify that, to the best of my knowledge, all statements in this application are complete and true. I agree and understand that any misstatement 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.
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
For official use only Accepted Not Accepted Initials Date 7/9/2022 X JM 7/11/22