SOUTH SAN FRANC The City of South San Francisco
Office of the City Clerk
ISCO 400 Grand Avenue
South San Francisco, CA 94080 RECD CITY CLERK
(650) 877-8518 (fax) (650) 829-6647 022 NOV 22 PM 1:36:37
CALIFORNIS
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 Authority Community Authority Hotel Committee (BAC) Representative Representative Representative Cultural Arts Housing
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
PERSONAL INFORMATION
Faria, Norman
Name (last. first. middle)
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? 47 Have you attended any meetings of the commission/board for which you are applying? Yes W No D Ifyes, which one(s)? Pianning
BPAC
Are you a resident of South San Francisco? Yes No
If no, are you employed in South San Francisco? Yes
Number of hours employed in South San Francisco:
Housing Authority Tenant Commission
Are you a resident of the Housing Authority? Yes NO D
Youth Commission - (Ages 14 to 22)
If not a resident of South San Francisco, are you a student of SSFUSD? Yes NO L Current school:
Conference Center Authoritv 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 iocate your District.
Why do you want to be a member of a Board/Commission/Committee? What do you feel you could contribute? Current member of Planning Commission completing 2nd Term What qualifies you for this appointment? 3 year of experience on Commission What is your vision for growth in South San Francisco? Implementation and execution of new General Pian Are you currently receiving any form of compensation from the City for work performed? Yes V No If yes, please explain: Planning Commission meeting compensation Do you have any relatives serving on Council, Commissions, Boards, and Committees or otherwise employed by the City of South San Francisco? Yes if yes.
Name Position Relationship
EDUCATION - Please include additional information on separate sheet.
Saramento City Coilege
Name and iocation of college/university/technical or trade school Degrees received Sacramento California
Consumnes River College
Name and location of college/university/technical or trade schooi Degrees received Elk Grove California
What community activities are you presently involved in, or have been in the past? Current member of Planning Commision and have served on other Commision over to past 20 year 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. 8/1981 to 6/20 See's Candies Warehouse and Distribution Manager Dates employed Employer Position
responsible for all Warehousing funtions and budgets, and Distribution of Candy to locations Duties
Dates empioved Empioyer 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
"/2/22
Signa 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
0 Grand Avenue. South San Francisco. CA 940
or more information. call (650) 877-85
1 For official use only I Not Accepted 1 Initials i Date 1 Accepted X FA 1/22/2022