Board Committee Application Form 2022

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Personal info

Name *

enter name here

Address *

Phone Number *

Email Address *

Qualifications

You must be 18 years of age
An Elector in the Town of Espanola

Selection

Please select which board/committee you are interested in sitting on below *

Committee of AdjustmentLibrary Board (elector of a contracting area)Non-Profit Housing BoardPolice Services BoardRecreation and Culture Advisory CommitteeAnimal Control Hearing Panel

If you have experience on any board/committee, please specify which ones and how long:

Please describe reasons for applying to server on the board(s) or committee(s)

Are you involved with and/or employed in a field related to the board and/or committee you are applying for?

YesNo

Certification

I certify that the facts set forth in this application are true and complete to the best of my knowledge. I acknowledge that the selection process may include verifying the information contained in this application. Personal information contained on this form is collected by the Corporation of the Town of Espanola inaccordance with the Municipal Freedom of Information and Protection of Privacy Act and will be used by the Council and staff to complete the boards and committee’s selection process; it may form part of the public record and may be made available to the public through requests and through the Town of Espanola website. Questions about this collection should be addressed to the Town Clerk.

Submit Signed Application to:
Joseph Burke
Clerk/Manager of Planning Services
Town of Espanola
100 Tudhope Street, Ste 2
Espanola, ON P5E 1S6

[email protected]