Application for Appointment to Council Appointed Committee(s) or Board(s)

Application for Appointment to Council Appointed Committee(s) or Board(s)
Please indicate the Committee(s) or Boards that you are interested in:*

Armstrong Public Library BoardEarlton Recreation Committee
Name*

First nameLast name
Address*

Home Address

Street Address Line 2

TownState / Province

Postal Code
Telephone No*
Email Address*
example@example.com
Are you a resident of the Township of Armstrong?*

YesNo
Are you 18 years of age or older?*

YesNo
Are you a youth volunteer?*

YesNo
State briefly what you consider your experience/qualifications to be for this Committee or Board.*
If you have served on a Board, Committee, or other organization, please specify:*
Note: A personal resume or synopsis outlining any additional information may be attached.

Cancelof
Declaration of Interest:

Members of Council appointment Committees and/or Board have a personal responsibility and a statutory duty to declare a direct or indirect pecuniary interest in any matter before the Committee in accordance with the provisions in the Municipal Conflict of Interest Act. I hereby acknowledge and agree that if appointed to a Committee or Board of the Township of Armstrong, I will subscribe to the Declaration of Interest.
Signature*

Clear
Date*

YearMonthDay
Date
Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act RSO, 1990 and will be used to determine eligibility for appointment. Questions about this collection of personal information should be directed to the Clerk, 35 Tenth St, Earlton, ON, POJ 1E0, Telephone: 705-563-2375.
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