The Corporation of the Town of Whitby Office of The Town Clerk 575 Rossland Road East Whitby, ON L1N 2M8 www.whitby.ca Phone: 905.430.4315 Fax: 905.686.7005 Email: clerk@whitby.ca

Application for the Appointment to a Board or Committee Applicant Last Name First Name

Address Unit No. City/Town Postal Code _____________________________________________________________________________ Email Address Business Phone No. Home Phone No.

Whitby Resident Yes No

Whitby Property Owner Yes No

Whitby Business Owner Yes No

Are you 18 years of age or older? Yes No

Are you able to attend daytime or evening meetings as required? Yes No

Questionnaire

1. Name of the Board or Committee(s) you are applying for:1st Choice: _______________________________________________2nd Choice: _______________________________________________

2. What are your qualifications and experiences with working on Boards orCommittees?

http://www.whitby.ca/mailto:clerk@whitby.camailto:clerk@whitby.cahttp:www.whitby.ca

3. If you have previously served on a Board or Committee in an elected or appointed capacityfor an agency, board or commission, ratepayer group or similar organization, please providedetails (include the name of the Board, Committee, Commission or group and your years ofservice).

4. Explain how your appointment will benefit the Board or Committee.

5. Please describe your relevant occupational background.

Resume 6. To complete your application we highly recommend that you attach a resume and/or cover

letter.

Resume attached Yes No

______________________________________________________________________________

Certification I hereby certify that the information contained in this application form is accurate.

______________________________________________________________________________ Signature Date

Office Use Only

Date Application # Committee Town Clerk Review

The personal information on this form is collected under the authority of the Municipal Act, 2001. The information is used to assess an applicants eligibility to serve on a Town of Whitby Board or Committee. Questions about this collection can be directed to: Town Clerk, 575 Rossland Road East, Whitby, ON L1N 2M8 or by telephone at 905.430.4315.

Application for the Appointment to an Advisory Board or CommitteeApplicantQuestionnaireResumeCertification

Last Name: 2nd Choice: Date: 1st Choice: First Name: City/Town: Postal Code: Property Owner: Business Owner: 18 Years of Age or Older?: Email Address: Are you able to attend daytime or evening meetings as required?: If you have previously served on a Board or Committee in an elected or appointed capacity for an agency, board or commission, ratepayer group or similar organization, please provide details (include the name of the Board, Committee, Commission or group and your years of service): What are your qualifications and experiences with working on Advisory Boards or Committees?: Explain how your appointment will benefit the Advisory Board or Committee: Please describe your relevant occupational background: Resume Attached?: Whitby Resident: Home Phone Number: Address Unit Number: Address: Business Phone Number: