Advisory Committee And Local Board Application Form - City Of Guelph (Page 2 of 2) in pdf

Advisory Committee And Local Board Application Form - City Of Guelph Page 2

Please list prior or current community involvement or experience with the

City or otherwise: (past experience is not necessarily a pre-requisite for

appointment)

City Council’s Policy Limits Membership on A Board Or Committee To A

Maximum Of Eight (8) Years. Indicate Below If You Have Served On The

Committee Before And If So, For How Many Years.

Have You Served On This Committee Before? Yes_____ No_____

No. Of

Years____

Please attach any additional information such as a resume or reference

letter which would assist in considering your application.

Signature:_______________________Date:_______________

By signing this form I confirm that I am 16 years of age and a

resident or owner of land in the City of Guelph; and, if selected to be

a member of a committee/board as the case may be, I agree to abide

by the rules of the Committee/board and attend meetings to the best

of my ability and understand that absence from meetings pursuant to

the policy or the terms of reference is grounds for my removal as a

member of the Committee.

Please return your completed application to the attention of:

City Clerk’s Office

or:

fax to 519-763-1269

City Of Guelph

or:

email to

clerks@guelph.ca

1 Carden Street

Guelph, ON N1H 3A1

If you would require assistance to complete this form or would like additional

information, please contact the City Clerk’s Office at (519) 837-5603.

Personal information, as defined by Section 2(i) of the Municipal Freedom of

Information and Protection of Privacy Act (MFIPPA) is collected under the authority of

the Municipal Act, 2001, and in accordance with the provisions of MFIPPA. Personal

information on this form will be used to assess the candidates qualifications for

appointment to one of the City’s various committees or boards. Personal information

may form part of meeting agendas and minutes, and therefore may be made

available to members of the public at the meetings, through requests, and through

the website of the Corporation of the City of Guelph.

Questions regarding the

collection, use, and disclosure of this personal information may be directed to the

Information, Privacy and Records Coordinator, City Clerk’s Office, 1 Carden Street,

Guelph, Ontario, N1H 3A1. The Nominating Panel reserves the right to check

references and verify information contained on these forms.

Advisory Committee And Local Board Application Form - City Of Guelph Page 2

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