Required fields are marked with asterisks (*)

Application for Municipal Appointment to the Durham Regional Police Service Board

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

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

Applicant Information

First Name:

Last Name:

Address:

City:

Postal Code:

Email address:

Home Telephone:

Business/Cell Phone:

Application Type

I am interested in serving on the Police Service Board:

A Community Member

A Regional Councillor (applicable after 2026 Municipal Elections)

Please specify your organization or industry (if applicable):

Eligibility

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

Yes

Are you able to attend daytime meetings?

Yes

Are you able to attend evening meetings?

Yes

Do you have a general understanding of the responsibilities of a Police Service Board Member?

Yes

Have you served, or do you currently serve, in a role that makes you ineligible for appointment to a Police Service Board (e.g., police officer, former DRPS member, judge, justice of the peace, criminal lawyer, or policing provider employee)?

Yes

Do you have a satisfactory police record check dated within the last 12 months or are you willing to obtain one as part of the application process?

Yes

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

Yes

Board and Committee Membership

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

Yes

Qualifications

1. Interest in the Position

2. Related Experience

3. 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

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

Yes

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

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

Yes

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.