Committee Member Application Form

3 weeks ago

Uxbridge, Canada The Township of Uxbridge Full time

**Volunteer - Committee Member Application Form**

**Personal Information**
**Name**:
**Address (including postal code)**:
**Home Phone: Alternate Phone**:
**Committee Preference and Supporting Information**
Please outline the Committee(s) you would like to sit on. Please note a résumé or expression of
interest which outlines why you should be appointed to the committee and the skills you will bring

**Volunteer Experience**
Do you have any experience volunteering? YES NO
If Yes, in what capacity:
**Accommodation**
We want to ensure persons with disabilities are able to participate on municipal committees. If you
have a disability, what accommodations, if any, would you need to carry out this position?

**Additional Information**
Please provide any additional information which may be of assistance in the selection process.

Applicants Signature:___________________ Date: ___________

Township of Uxbridge documents are available in alternate formats upon request. Please fill out the
- The Township of Uxbridge is an Equal Opportunity Employer that is dedicated to an inclusive, barrier-free recruitment and selection _
- process. The Township is committed to diversity, equity, and inclusion within its community and organization, and welcomes and _
- 2SLGBTQI+ communities, and people from diverse communities. When requested, the Township of Uxbridge will accommodate _
- applicants throughout the recruitment and selection and/or assessment process, pursuant to the Ontario Human Rights Code. These _- Personal information is collected in accordance with the Municipal Freedom of Information and Protection of Privacy Act._

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