Application for Committee Appointment

Contact Information

Committee/Board of Interest

Please indicate which Committee(s) / Board(s) you are interested in serving on in order of preference (please select all that apply)*:

Disability Disclosure

Explain why you would like to serve on the Committee(s) you listed above

Special Skills or Qualifications

Summarize the skills and qualifications you have acquired from employment, previous volunteer work, or through other activities that relate to the committees or board(s) to which you have applied. Where relevant please attach a current resume.

Agreement and Signature

By submitting this application, I affirm that the facts set forth herein are true and complete to the best of my knowledge. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal from the appointment. I further agree to serve on the above-noted board or committee(s) if appointed and have reviewed the committee(s)’ description and terms of reference and am able to regularly attend meetings.

Submission Information

The information contained in your application submission is being collected pursuant to the Municipal Act S.O. 2001, ch.25. Any personal information contained in this form will be used solely to assess applicants’ qualifications for appointment to one of the Town’s Committees/Boards, in accordance with the requirements of the Municipal Freedom of Information and Privacy Act.

Please direct Inquiries about the Town of Ingersoll’s Boards and Committees and the appointment process to the Clerk’s Department.