Application to Join a Board or Committee

Application for Citizen Appointment to a Board or Committee of Council
City of Kawartha Lakes
City Clerk's Office
26 Francis Street, PO Box 9000
Lindsay, Ontario K9V 5R8
clerks@kawarthalakes.ca

Note: Please complete this Application in its entirety. Should this Application not be fully completed, the City reserves the right to reject the Application. In addition, the provision of any false or misleading information on this Application will be sufficient reason for the City to reject the Application or to terminate an appointment.

Please submit the completed Application to:
The City of Kawartha Lakes
26 Francis Street, P.O. Box 9000
Lindsay, Ontario K9V 5R8
Attention: City Clerk's Office
Fax: 705-324-8110
Telephone: 705-324-9411
Email: clerks@kawarthalakes.ca

Name:

Address:

City/Town/Village:

Province:

Postal Code:

Telephone Number:

Email Address:

Indicate which Board, Committee of Council, or Position the application is being submitted for:

Check all that apply to you:

A resident of the City (own, rent, live in shared accommodation where you do not pay rent or live in the municipality with no fixed address)

An owner of property in the City or a person who rents property in the City, or the spouse of the above.

18 Years of Age or Older

A Canadian Citizen or a permanent resident of Canada

Applying for a Reappointment

List the real property owned/rented in the City of Kawartha Lakes by yourself or your spouse:

Do you currently sit on a City Committee, Board or Task Force?

Yes

No

Have you sat on a City Committee, Board or Task Force in the past?

Yes

No

Are you applying concurrently to any other Position, City Committee, Board or Task Force?

Yes

No

Explain why you would like to serve on the Board or Committee of Council or citizen appointed position:

Please summarize any previous experience related to the position you are applying for.

In the field below please state, in detail, your experience: work related, community service oriented, or other volunteer activities which illustrate the interest, skills or abilities you may contribute. Please attach a current resume, if available.

I acknowledge and agree to complete any and all mandatory training programs that are imposed by The City of Kawartha Lakes if I become a member of a Board, Advisory Committee of Council or Task Force.

No

Yes

Please upload a current resume.

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References:

In the fields below please list the name and contact phone number for your references. By applying your signature to this application, you authorize the City of Kawartha Lakes to contact the following persons or organizations and authorize them to disclose to the City any required information.

Name/Organization:

Association with Person:

Telephone Number:

Name/Organization:

Association with Person:

Telephone Number:

Name/Organization:

Association with Person:

Telephone Number:

Applicant's Signature:

Name:

Signature:

Clear

Date:

Personal information contained on this form is collected pursuant to The Municipal Act, 2001, and will be used for the purpose of responding to your request. Questions about the collection of this information should be directed to the City Clerk or Deputy Clerk at clerks@kawarthalakes.ca.

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Application to Join a Board or Committee

Please submit the completed Application to:The City of Kawartha Lakes26 Francis Street, P.O. Box 9000Lindsay, Ontario K9V 5R8Attention: City Clerk's OfficeFax: 705-324-8110Telephone: 705-324-9411Email: clerks@kawarthalakes.ca

References:

In the fields below please list the name and contact phone number for your references. By applying your signature to this application, you authorize the City of Kawartha Lakes to contact the following persons or organizations and authorize them to disclose to the City any required information.

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Please submit the completed Application to:
The City of Kawartha Lakes
26 Francis Street, P.O. Box 9000
Lindsay, Ontario K9V 5R8
Attention: City Clerk's Office
Fax: 705-324-8110
Telephone: 705-324-9411
Email: clerks@kawarthalakes.ca