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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:

Communities in Bloom

Fantasy of Lights

Kingsville Accessibility Advisory Committee**

Migration Festival

Please note that the Accessibility for Ontarians with Disabilities Act, 2005 requires that a majority of the Accessibility committee members be persons with disabilities. Do you identify yourself as having a disability?

Yes

Prefer not to identify

Do you want to upload a cover letter and resume?

Yes

References

Please list three career or volunteer related references below. Please exclude family members.

1. Reference Name

Reference Phone Number

Relationship to Reference

2. Reference Name

Reference Phone Number

Relationship to Reference

3. Reference Name

Reference Phone Number

Relationship to Reference

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 Town Clerk, 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

References

Please list three career or volunteer related references below. Please exclude family members.

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