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Nomination to Committees and Boards

Personal information collected on this form is subject to the Municipal Freedom of Information and Protection of Privacy Act and will be used only for the purpose of recruiting individuals to Municipal Boards, Committees and Commissions. Information collected on this form will be disclosed to Council for candidate selection purposes only.

Name of Committee / Board

Requirements

18 years or older

Canadian citizen

Clarence-Rockland Resident

Name

Address (street, city, province)

Postal Code

Telephone

Email:

Why do you want to serve on this committee or commission?

Please state, in detail, your experience: professional experience, community service experience or other volunteer activity which would demonstrate your interest, skills or abilities in this field. You may attach your current resume.

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Education (please indicate your highest grade)

References

By signing this application form, you hereby authorize the municipality to contact the individuals or organizations noted below, and you authorize those individuals and organizations to disclose any required information to the municipality.

Name

Relationship

Telephone

Name

Relationship

Telephone

Name

Relationship

Telephone

Signature of applicant

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Date

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Nomination to Committees and Boards

References

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