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:
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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:
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