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Citizen Appointments to Boards and Committees Application Form

For additional information regarding appointments to boards and committees, including Terms of Reference, please visit www.clarington.net/committees.

All applicants must be residents of the Municipality of Clarington.

Are you a Clarington resident?

Yes

Name

Please enter your preferred pronouns or suffix (e.g. Mr. Mrs. Ms etc.)

Address

Town/Hamlet

Postal Code

Phone number

Alternate Number

Email Address

Consent Statement

By checking this box, I am providing my word that I have read, and accept, the Terms of Reference for this Board or Committee. Should this application form not be fully completed, the Municipality reserves the right to reject the application. In addition, the provision of any false or misleading information on this application form will be sufficient reason for the Municipality to reject the application or to terminate an appointment.

Personal information collected on this form will be used to determine suitability for appointments to Boards and Committees and is gathered under the authority of the Municipal Act. Please direct questions about this collection of information to the Municipal Clerk, 40 Temperance Street, Bowmanville, ON L1C 3A6 or 905-623-3379 ext. 2102.

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Citizen Appointments to Boards and Committees Application Form