Required fields are marked with asterisks (*)

Board and Committee Application Form

First Name:

Last Name:

Address:

Phone Number:

Email:

Preferred method of contact:

Telephone

Skills and Qualifications: (please list any relevant experience)

Interests and Hobbies:

Are you the owner or tenant (or the spouse of an owner or tenant) of property in the Town of Prescott?

Yes

Are you 18 years of age or older?

Yes

Are you legally entitled to work in Canada?

Yes

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 one of the various committees or boards. At no time will your personal information be disclosed without your express written consent. Questions regarding the collection, use and disclosure of this personal information may be directed to the Freedom of Information Coordinator, Clerk’s Office, 360 Dibble Street 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.

Signature

Clear

Thank you for considering volunteering with the Town of Prescott as a member of one of our Boards and Committees. We are committed to reviewing your application within 30 business days.