Required fields are marked with asterisks (*)

Application Form -

Appointments to Boards & Committees

First Name

Last Name

Mailing Address

City

Postal Code

Phone Number (Home)

Phone Number (Cell)

Phone Number (Work)

Email Address

Name of Board or Committee of Interest

Business/Work Experience in the Past five (5) Years (if retired, indicate your previous occupation).

Explain how your business/work experience or educational background is related to the mandate of the Board/Committee.

What skills, abilities or specialized knowledge do you have that will assist this Board/Committee?

State why you are interested in serving on this Board/Committee. Note: If you are a non-resident please demonstrate the nature of your interest in the Tay Valley Community (ex. born here, proximity of residence or work).

Have you read the Board/Committee description and are able to commit the time required to carry out these duties?

Yes

Identify any previous service on Tay Valley Boards or Committees and when you served.

If you would like to apply to more than one Board or Committee (up to 3), please check the box below.

I would like to apply to more than one Board or Committee

Add any additional information you wish to provide (i.e. resume)

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Personal Information

Personal information collected from applications is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, and will be used to determine qualification for any Board or Committee. Questions about the collection of information should be directed to the Clerk at 217 Harper Road, Perth, ON, K7H 3C6 or by phone at 613-267-5353 ext. 123 or by email at clerk@tayvalleytwp.ca.

By clicking "Accept" below, I confirm that I have read, understood and agree to the information above.

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