Application for Appointment to Region of Durham Advisory Committees

Please submit a separate application for each Committee, if applying to more than one.

For additional information regarding Boards and Committees, including Terms of Reference, please visit the Committees page on the Region of Durham website.

If you require this information in an alternate accessible format, please contact the Accessibility Coordinator at accessibility@durham.ca or 311 (within regional limits) extension 2097

Indicate which Committee this application is being submitted for:

Please select one radio button:

Accessibility Advisory Committee (AAC)

Durham Agricultural Advisory Committee (DAAC)

Durham Region Anti-Racism Taskforce (DRART)

Durham Region Transit Advisory Committee (TAC)

Energy from Waste - Waste Management Advisory Committee (EFW-WMAC)

Durham Active Transportation Committee (DATC)

Other: Durham Environment and Climate Advisory Table (DECAT)

Applicant Information

First Name:

Last Name:

Address:

City:

Postal Code:

Email address:

Home Telephone:

Business/Cell Phone:

Eligibility

Do you live or work in The Regional Municipality of Durham?

Yes

No

Do you attend an elementary, secondary or post-secondary institution in The Regional Municipality of Durham?

Yes

No

Are you able to attend daytime meetings?

Yes

No

Are you able to attend evening meetings?

Yes

No

Do you use public transit in The Regional Municipality of Durham?

Yes

No

Would you have any conflicts of interest or potential conflicts of interest if you were appointed?

Yes

No

Board and Committee Membership

Are you a current member of any Region of Durham Boards or Committees?

Yes

No

Qualifications

1. Interest in the Position

2. Related Experience

3. Community Involvement and Interests

4. Previous Board and Committee Experience

Optional Socio-Demographic Questions

The Regional Municipality of Durham is committed to equitable representation on its Boards and Committees and encourages applications from Indigenous Peoples, people with disabilities, racialized people, women, newcomers, and individuals from other underrepresented groups.

You are encouraged to complete this confidential questionnaire. This information will be used to help the Region in achieving its objectives for access, equity, diversity, and reconciliation.

Gender:

Man

Woman

Non-binary

Trans

I self-identify as:

Age:

under 18

18-24

25-34

35-44

45-54

55-64

65+

Do you identify as having a disability?

Yes

No

Do you identify yourself as an Indigenous person (First Nations, Métis or Inuit)?

Yes

No

Resume

To complete your application, we encourage you to attach a resume and/or cover letter.

Would you like to include a copy of your resume?

Yes

No

Would your like to include a copy of your cover letter?

Yes

No

Applicant Signature/Certification

I hereby certify that the information contained in this application form is accurate and complete and by signing, or by typing my name below will constitute an electronic signature:

Applicant Signature:

Clear

Applicant Signature:

Date of Application:

Privacy Statement:

Personal information contained on this form is collected pursuant to the Municipal Act 2001, and in accordance with the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Personal information on this Application will be used to assist in the selection of appointees to Regional committees and may be subject to disclosure under the MFIPPA. Questions regarding the collection, use and disclosure of personal information should be directed to the Corporate Privacy Officer at foi@durham.ca, 905-668-7711 extension 2204 or 1-800-372-1102.