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HomeMy WebLinkAboutFILLABLE-MUNICIPAL_ELECTION_COMPLIANCE_AUDIT_COMMITTEE_APPLICATION_FORMApplication for Appointment to Municipal Elections Compliance Audit Committee Submit only one application per person; attachresume, if applicable. Please Print or Type Application Deadline is Friday, July 20,2018 Personal Information: Mr.Mrs.Ms. (Please choose one) Name: Home Address: StreetCityPostal Code Mailing Address: (If different than above)StreetCityPostal Code Telephone:HomeBusiness E-Mail:________________________________________________ List all advisory committees or special purpose bodiesthat you are presently serving on or were previously appointed toby anymunicipality. From(date)To(date) 1. to 2. to 3. to Relevant Educational Background: Relevant Occupational Background: 824977 What qualifications can you bring to the Municipal Elections Compliance Audit Committee? Please include any other reasons for applying or informationthat you think would be helpful in making a decision. Are you available to attend meetings: During business hours?Yes No In the evening hours?YesNo Does travel within the Region of Waterloo and the City of Guelph pose a problem? During business hours?Yes No In the evening hours?YesNo I agree that, if appointed, I will abide by all applicable policies established relating to the Conflict of Interest policy. I am a property owner or resident of the Region of Waterloo or the City of Guelph being 18 years of age or older. Signature Date Return to: Office of the Regional Clerk Regional Municipality of Waterloo nd 2Floor, 150 Frederick Street Kitchener ON N2G 4J3 Phone 519-575-4400 or Fax 519-575-4481 Email: regionalclerk@regionofwaterloo.ca Personal information is collected under the authority of the Municipal ElectionsActand will be used to determine suitability for appointment.Questions regarding the collection of personal information should be directed to the above noted, Office of the Regional Clerk. Applicants are responsible to ensure that their application has been received by the Regional Clerk. For Office Use Only: Application copied to Regional ClerkDate: Appointment approved by Area ClerksDate: Notification letter sentDate: 824977