The City of South San Francisco
Office of the City Clerk
CO 400 Grand Avenue
South San Francisco, CA 94080
(650) 877-8518 (fax) (650) 829-6641
CALIFORNIA
Application for Boards and Commissions :42
APPLYING FOR (more than one may be checked)
Bicycle and Conference Center Conference Center Conference Center Pedestrian Advisory Authority Business Authority Community uthority Hot Committee (BPAC) Representative Representative presentativ DE Cultural Arts Housing 707
Equity and Public Housing Authority
Commission Safety Commission Authority
Tenant Commission
Library Measure W Citizens' Parking Place
Board Parks & Recreatior
I Oversight Committee Commission Commissior
Personnel Planning SSF General Plan 2040 Traffic Safety • Board Community Advisory
Commission Commission
Committee
Youth
Commission
Are you interested in participating in the Citizen's Academy? Yes • NO
PERSONAL INFORMATION
Cesilia Baeza
Name (last, first, middle)
South San Francisco
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? 17 Have you attended any meetings of the commission/board for which you are applying? Yes No VI If yes, which one(s)? _
BPAC
Are you a resident of South San Francisco? Yes V
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 MA 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.
Why do you want to be a member of a Board/Commission/Committee? What do you feel you could contribute? My interest in being a Cultural Arts board member originated in San Francisco where I was born and raised.
What qualifies you for this appointment? My current job requires extensive awareness of city ordinance and What is your vision for growth in South San Francisco?
The current demographic is changing in South San Francisco which means every aspect of our :
Are you currently receiving any form of compensation from the City for work performed? Yes No LI 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.
San Francisco State University
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.
Current The Shanti Project
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.
12/19/2022
siguature 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
1 10m12/1/22