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? ____
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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 enjoy mak ng a pos t ve
d fference by sten ng, earn ng, co aborat ng, and advocat ng for P&R programs and serv ces for our ent re commun ty to enjoy. have demonstrated a strong commitment to being an active thoughtful and effective P&R Commissioner n relation to the P&R Commission my vision as our city grows is that we remain adaptable cont nuous y mov ng forward to prov de access b e, we -run, qua ty-of- fe mprov ng P&R programs to serve our ever chang ng commun ty.
I receive a stipend for being on the Parks and Recreation Commission Hector Camacho Library Board Spouse
American Military University, Manassas, VA M.A., Political Science, Specialization in Public Policy (2010) George Washington University, Washington DC M.B.A. Org. Behavior & Development & Human Resources Mgmt (2004) University of California, Los Angeles B.A. Psychology, Minor/Specialization in English & Business (2001) SSF Education Foundation Vice President / Founding Board (2022 - Present), General Plan CAC, Improving Public Places Committee, Monte Verde PTA Committee Chair/Board Member (2017-Present), SSF Mothers Club Board (2014-2018) 2005-Present United States Coast Guard Funds Manager
Manage Deployable Specialized Forces training funds/budget to achieve agency’s mission priorities 2003-2005 United States Patent & Trademark Office Exec. Management Associate Manage agency-wide projects, providing research/ analytical support to the Chief Financial & Administrative Officers ✔
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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 December 12, 2022