Fillable Boards And Committees Application Form printable pdf download

BOARDS AND COMMITTEES

APPLICATION FORM

Boards and Committees Secretariat

P.O. Box 2703, CM-1, Whitehorse, Yukon Y1A 2C6

Telephone (867) 667-8688, toll free 1-800-661-0408

Email:

Boards.Committees@gov.yk.ca

Legal First Name: ___________________________________

Middle Name: _____________________________________

Last Name: ________________________________________

Mailing Address: __________________________________

____________________________________________________________________________________________________________

Phone number (day): ________________________________

Phone number (evening): ___________________________

Email Address: ______________________________________________________________________________________________

Please complete and submit the following documents to the above address:

Application form

Cover letter (Optional)

Résumé

Board Selection: See our webpage for a list of boards and committees

I am interested in serving on the following boards and committees:

1. _________________________________________________________________________________________________________

2. _________________________________________________________________________________________________________

3. _________________________________________________________________________________________________________

4. _________________________________________________________________________________________________________

Cover Letter Content:

On a separate piece of paper, please describe how your experience, training, and / or education makes you well suited to

the boards / committees you have indicated above, and any previous experience you have serving on a board / committee.

Résumé:

Please provide a brief résumé that contains information you feel is relevant to the boards and committees on which you

wish to serve.

Diversity:

The Yukon Government is committed to membership on government boards and committees that is representative of

Yukon society, including gender, age, First Nations people, youth, visible minorities and people with disabilities. To en-

sure the nominations and appointments reflect this commitment, we ask that you provide the following details:

Length of residence in Yukon: ____________________

What is your gender? _____________________________________

What is your age? ______________________________

Do you identify as a person with a disability? _________________

Are you a First Nation person? ____________________

If yes, what First Nation do you belong to? _____________________________________________________________________

If no, what ethnicity / ancestry do you identify with? _____________________________________________________________

Where did you hear about Yukon Government boards and committees?

Newspaper

Internet

Word of Mouth

Other _______________________

The personal information requested on this application form is being collected and used by the Boards and Committees Secretariat and its processes,

and may include an all-party committee of the Legislative Assembly, to evaluate the suitability of potential candidates for appointment to a Yukon board or

committee. This information will not be disclosed except as required for the above-noted purposes. Any questions about the collection, use, or disclosure of

personal information requested on this form should be directed to the Boards and Committees Secretariat at (867) 667-8688 or toll free 1-800-661-0408.

I understand and consent to the use of my personal information for the above-noted purposes. I also consent to named organizations being contacted.

Signature: ___________________________________________________

Date:_______________________________

YG(3538)F1 Rev.02/2016

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