Application for Advisory Committees

Name:

Address (including postal code):

Telephone:

E-mail:

Minimum Requirements: (may vary by committee)

Check the following that apply to you:

A Canadian Citizen

18 years of age or older

A resident of Stratford or an eligible elector in Stratford

I have reviewed the day and time of the meetings and I am able to attend in person

If applying for more than one committee or board, please complete a separate application form for each committee or board.

If you are applying for the Accessibility Advisory Committee, please check the applicable box:

I am a person with a disability.

I am familiar with issues affecting persons with disabilities.

Not Applicable

What is your understanding of the mandate or responsibilities of the committee?

What interests you most about the committee?

How does your previous experience serving on committees or boards in the community enhance the work of the committee

What are you hoping to achieve by being on the committee?

I acknowledge, that if appointed as a member of this advisory committee, I am governed by all applicable legislation, City By-laws and policies for the conduct of meetings and activities, including but not limited to:

Code of Conduct
Policy for Procurement of Goods and Services
Procedural By-law for the Conduct of Meetings
Policy for Hiring of Employees
Municipal Act and Municipal Conflict of Interest Act
Accessibility for Ontarians with Disabilities Act and Regulations

By submitting this application for consideration, you are declaring that the information in your application is true. The City of Stratford is committed to workplace diversity and inclusion, and this commitment extends to our Committee appointments. An inclusive workplace creates a more supportive environment and ultimately helps us to provide better service to our diverse community.

Aboriginal/Indigenous Peoples are those who identify as members of First Nations (status, non-status, treaty, or non-treaty), Inuit or Metis communities in Canada. Based on this description, do you consider yourself to be an Aboriginal/Indigenous person?

Yes

No

Prefer not to answer

Member of a visible minority means anyone other than aboriginal/indigenous peoples who are non-Caucasian in race or non-white in colour. We recognize that this language is outdated and that the term racialized is becoming more common. The Ontario Human Rights Commission explains that because race has its roots in social, not biological, characteristics and includes much more than skin colour, their preferred term is racialized group or person. We are using the term visible minority, not racialized group, because it is the term used by Statistics Canada in its census data.

Based on this description, do you consider yourself to be a member of a visible minority?

Yes

No

Prefer not to answer

The term disability covers a broad range and degree of conditions, some visible and some invisible. A disability may have been present at birth, caused by an accident, or developed over time. These include physical disabilities, hearing or vision disabilities, developmental disabilities, learning disabilities, chronic illness and mental health disabilities and addictions. A disability may be permanent, temporary, or episodic which may result in experiencing disadvantage or barriers to full participation in society.

Based on this description, do you consider yourself to be a person with a disability?

Yes

No

Prefer not to answer

Municipal Council approves all appointments. The appointment process is governed by Council’s policy on Advisory Committees. For more information, please contact the City Clerk's Office at 519-271-0250 ext. 5237.

How did you hear about this opportunity?

City website

Social media (e.g. Facebook)

Friend or co-worker

Printed newspaper advertisement

Other - specify

Personal information collected on this application is gathered in accordance with the Municipal Act, for use when making appointments to City Boards and Advisory Committees. The information on this application will be provided to City Council for selection of members to serve on City Boards and Committees. The information contained on this form may be subject to disclosure under the Municipal Freedom of Information and Protection of Privacy Act if circumstances warrant. Inquiries about the Act may be directed to the Clerk at (519) 271-0250, ext. 329.

Signature of Applicant:

Clear

Date: