Form

Form
Town of Prescott Library Board

Application form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Preferred Method of Contact *
Skills & Qualifications: (Please list any relevant experience)*
Interests & Hobbies*
Are you the owner or tenant (or spouse of an owner or tenant) of property in the Town of Prescott?*

YesNo
Are you 18 years of age or older?*

YesNo
Are you legally entitled to work in Canada?*

YesNo
Notice of Collection:

Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) is collected under the authority of the Municipal Act, 2011, and in accordance with the provisions of the MFIPPA. Personal information on this form will be used to assess the applicant's eligibility for volunteer positions or qualifications for appointment to the Prescott Library Board. At no time will your personal information be disclosed without your express written consent. Questions regrading the collection, use and disclosure of this personal information may be directed to the Freedom of Information Coordinator, Clerk's Office, 360 Dibble St West, Prescott, ON K0E 1T0, 613-925-2812.
Declaration:*

I hereby declare that the foregoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from volunteering or may cause my dismissal from volunteering.
Should be Empty:

Form

Town of Prescott Library Board