Advisory Committee & Local Board Application Form

Advisory Committee Application Form

Please complete the form below to apply for a committee position with us.
Full Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

cityProvince

Postal / Zip Code
Email Address
example@example.com
Advisory Committee or Board to which you are seeking appointment:*
The majority of members on the Equity, Diversity, and Inclusion Advisory Committee shall be persons representing the defined equity- and inclusion- seeking groups. In considering the appointment of members Council shall consider the following: a) The need for representation from various equity- and inclusion-seeking groups including, but not limited to, people with disabilities, francophones, Indigenous people, newcomers, older adults, racialized community members, rural residents, 2SLGBTQIA+, those facing socioeconomic disadvantage, women, minority faith-based and spiritual group members, and youth; b) The need for representation from different geographic areas within the municipality; and c) The skills, experience, and expertise of the individuals being considered for appointment. Please select all that apply to your identity:

Person with a disability (please find the Accessibility for Ontarians with Disabilities Act disability definition at www.ontario.ca/laws/statute/05a11#bk2)FrancophonesIndigenous ( Under the Employment Equity Act, an Indigenous person (“Aboriginal person”) is a North American Indian, Métis or Inuit, or a member of a North American First Nation as recognized in the Constitution Act, 1982. An Aboriginal person may have treaty status, be non-status, registered or non-registered Indian.)Newcomers (A new Canadian is considered as someone who has lived in Canada for less than 10 years)Older adultRacialized (The term ‘visible minority’ is often used interchangeably with ‘Racialized Persons’. Visible minority is defined “as persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour”.)Rural residents2SLGBTQIA+Facing socioeconomic disadvantageWomanMinority faith-based or spiritual group membersYouthPrefer to specify
The majority of members on the Indigenous Advisory Circle shall be Indigenous. In considering the appointment of members to the Committee, Council shall consider the following: a) The majority of members of the IAC shall be Indigenous, ensuring that the perspectives and concerns of the Indigenous community are adequately represented in the committee's discussions and recommendations. b) Council shall consider the expertise and experience of potential members in relation to the mandate of the IAC. This may include experience in Indigenous governance, community development, or other relevant fields. Under the Employment Equity Act, an Indigenous person (“Aboriginal person”) is a North American Indian, Métis or Inuit, or a member of a North American First Nation as recognized in the Constitution Act, 1982. An Aboriginal person may have treaty status, be non-status, registered or non-registered Indian. Does the definition above match your cultural and/or ancestral background?

YesNoPrefer to specify
The terms of reference for the Accessibility Advisory Committee require the majority of the members to have a disability. Do you have a disability?

YesNoPrefer not to answer
The Municipality of North Grenville is committed to advancing equity, diversity, and inclusion in every aspect of its work, including appointments to advisory committees. An increase in diversity can assist in promoting equal opportunities and memberships with a diversity of lived experiences. A more diverse membership will contribute to the work ofeach advisory committee. Each advisory committee shall endeavour to have balanced representation from various equity- and inclusion-seeking groups. Please select all that apply to your identity:

Person with a disabilityFrancophonesIndigenousNew Canadian/ImmigrantOlder adultRacializedRural residents2SLGBTQIA+Facing socioeconomic disadvantageWomanMinority faith-based and spiritual group memberYouth
How did you hear about this position?
Have you ever been or are you currently a member of any Municipal Committee(s) or Board(s)?

YesNo
If YES, please list below:
Please state the reasons for seeking appointment to the Committee and any other information you feel may be helpful in considering your application.
Please list the skills, qualifications, and knowledge you would bring to the Advisory Committee position.
Please list your lived experience and knowledge you would bring to the Advisory Committee position.
Please list prior or current community involvement or experience with the Municipality: (past experience is not a pre-requisite for appointment)
Please attach any additional information such as a resume or reference letter which would assist in considering your application.

Cancelof
By signing this form, I confirm that I am 18 years of age, a Canadian citizen and a resident or the owner or tenant of land in the of the Municipality of North Grenville; and, if selected to be a member of a Committee(s), I agree to abide by the rules of the Committee(s), 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.
Date:

MonthDayYear
Need assistance?

If you would require assistance to complete this form or would like more information, please contact the Deputy Clerk at 613-258-9569 ext. 171.
Disclaimer

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 candidate’s qualifications for appointment to the Municipality’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 Municipal website. Questions regarding the collection, use, and disclosure of this personal information may be directed to the Clerk’s Office at the address listed above.
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Advisory Committee Application Form

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