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Application - Appointment to Committees and Boards

I am applying to serve on

Eligibility Criteria (Each Committee may have additional criteria for eligibility - Refer to Terms of Reference

I am not prohibited from voting in a municipal election

I am a resident or owner/tenant of land in the Town of Amherstburg

I am at least 18 years old

Do you meet the qualifications for your chosen Committee/Board?

Yes

Are you currently serving on a Town of Amherstburg Board or Committee?

Yes

Personal Data - Mailing Address and Contact Information

Full Name

Address

Postal Code

Email Address

Phone Number

Alternate Phone Number

Explain why you would like to serve on the committee (upload a separate document if necessary)

Attach your explanation (if it doesn't fit above)

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Personal Experience - State, in detail, your experience: work related, community service oriented or other volunteer activities which illustrate the interest, skill sets or abilities you possess that would make you a good candidate for the Committee.

Please upload a current Resume

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Please indicate the highest academic level you have attained:

References

By submitting this application, you authorize the Town to contact the following persons/organizations, and authorize them to disclose any information required to assist in the evaluation of your application to this Board

Please State Reference: Name(s), Associations to the Reference(s), and Phone Number

Note: Applicants may be requested to attend an interview if additional information is required. Alll applications will be considered and a recommendation submitted to Town Council for final approval.

Personal information contained on this form is collected under the authority of the Municipal Act, 2001 (and other applicable legislation) and will be used only for the purpose of recruitment of individuals to Boards and Committees for the Town of Amherstburg. Information on this form will be disclosed to member of your local Municipal Council and Administration for candidate selection purposes only. Questions about the collection of information or about the selection process in general, should be directed to the Municipal Clerk at the address indicated at the top of the application form.

Date of Submission

Applicant Signature

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