Required fields are marked with asterisks (*)

Self Nomination Form

Position: Advisory Committee member, A Fenceviewer, or a Livestock Investigator Position.
Please submit only one application per person; include additional materials if applicable.

Advisory Committee(s) or Position(s) interested in (1st Choice)

Advisory Committee(s) or Position(s) interested in (2nd Choice)

Are you available for daytime meetings?

Yes

Meeting Time Preference

Daytime

Evening

Both daytime and evening meetings work for me.

Name

Full Address

Phone Number

Email Address

Reasons for Seeking Appointment/List Qualifications Ideal to Committee/Position

List Township Advisory Committee(s) or Position(s) you have served on or currently hold, and the number of years served.

Additional Information that may be Helpful in Consideration of Your Application (including previous community involvement – relevant information or resume can be attached on the next question if needed)

Please include relevant information (CV, resume) here.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Signature

Clear

Date

PURSUANT TO THE MUNICIPAL FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT, THE PERSONAL INFORMATION CONTAINED ON THIS FORM WILL BE USED SOLELY TO ASSESS YOUR QUALIFICATIONS FOR APPOINTMENT TO ONE OF THE TOWNSHIP’S ADVISORY COMMITTEES.