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Application for Appointment to Board or Committee

Applicant Name

Applicant Address

City

Telephone number

Cell Phone number

Email address

Please list the board(s) and/or committee(s) for which you apply to be appointed:

If you are applying for the Accessibility Advisory Committee, please note that the Accessibility for Ontarians with Disabilities Act, 2005 requires that a majority of the committee members be persons with disabilities.

Do you identify yourself as having a disability?

Yes

Prefer not to identify

Please indicate what interests you have about the board(s) and/or committee(s) that you have listed above:

Please indicate the education and work experience that you have which would make you particularly suited for appointment to the board(s) and/or committee(s) that you have listed above:

Please identify the skills that you have which would be of benefit to the board(s) and/or committee(s) that you have listed above:

(Optional) If you wish to attach a cover letter and resume, please do so here.

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Date

Signature

Clear

Personal information collected in this application is collected for the purpose of selecting an individual to serve on a committee or local board. Personal information is collected and disclosed pursuant to the provisions of the Municipal Freedom of Information and Protection of Privacy Act. Questions about the collection of this information may be directed to the Director of Legislative Services, The Corporation of the Town of Kingsville at 2021 Division Road North, Kingsville, Ontario N9Y 2Y9 or (519) 733-2305.

Application for Appointment to Board or Committee

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