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 Conterence Center Conference Center Conference Center Pedestrian Advisory Authority Business Authority Community Authority Hotel Committee (BPAC) Representative Representative Representative Housing
Cultural Arts Equity and Public Housing Authority
Commission Safety Commission Authority Tenant Commission Library Measure W Citizens Parking Place Parks & Recreation Board Oversight Committee Commission Commission
Personnel Planning SSF General Plan 2040 Traffic Safety Board Commission Community Advisory Commission
Committee
• Youth
Commission
Are you interested in participating in the Citizen's Academy? Yes One Already attended, but happy to octten again.
PERSONAL INFORMATION
Mary Giusti
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? lifetime Have you attended any meetings of the commission/board for which you are applying? Yes M No If yes, which one(s)? Library Board - I'm currently the VP, pending President position in January 2023 BPAC
Are you a resident of South San Francisco? Yes
If no, are you employed in South San Francisco? Yes | NO D Number of hours employed in South San Francisco:
Housing Authority Tenant Commission
Are you a resident of the Housing Authority? Yes No I
Youth Commission - (Ages 14 to 22)
If not a resident of South San Francisco, are you a student of SSFUSD? Yes No DI 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? Lifelong library user and supporter; reader; attend programs; advocate for the library; took my family and now my grandchild to the library What qualifies you for this appointment? Big library advocate; former Planning Commissioner; excited about New Main Library What is your vision for growth in South San Francisco? Can't wait for the grand opening of the New Library, Parks and Recreation Center with programs and services that will meet the needs of SSF residents as the City grows and thrives Are you currently receiving any form of compensation from the City for work performed? Yes V NoL If yes, please explain: Library Board member stipend
Do you have any relatives serving on Council, Commissions, Boards, and Committees or otherwise employed by the City of South San Francisco? Yes L NO M 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 San Mateo Junior College
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? SSF Historical Society Board member; active in SSF Women's Club; SSF Beautification Committee 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. 1948-1993 City of SSF various
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.
11-302022
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 vritten communication. The Mayor shall report to the City Council the reasons provided for the member's absences. If the City Counci letermines that the absences occurred for legitimate reasons, the City Council may excuse both or one of the absences. Members are als encouraged to give advanced notice of their absence from meetings. pplications are accepted on a continuous basis and will remain valid 1 year from the date of submission. If you are selected to serve on oard or Commission, you may be required to file an Annual Statement of Economic Interest (FPPC Form 700) and bi-annual Ethi Training (AB1234).
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CITY OF SOUTH SAN FRANCISCO
For official use only Accepted Not Accepted Initials M.L. Date 12/1/22