Committee Volunteer Application Form

First Name

Last Name

Address

Phone

	Please check all that apply to you:
18 years of age or older	18 years of age or older
Canadian Citizen	Canadian Citizen
Resident of Middlesex County	Resident of Middlesex County

	I am interested in the following committee(s): (please select all that apply)
Middlesex Accessibility Advising Committee	Middlesex Accessibility Advising Committee
Planning Advisory Committee	Planning Advisory Committee
Library Board	Library Board

Indicate your preferred choice of Committee/Board:

Are you available to attend meetings and other events during business hours?

Yes

Please specify any experience you may have serving on a board, commission, committee, utility group or other organization in any municipality.

Why are you interested in serving on the Committee/Board of Council for which you have applied?

Please provide any other relevant experience or information that you think would be helpful to Council in making a decision to appoint you to a Committee/Board.

Date

Understanding of Commitment and Expectations of Applicant

By submitting this form, I hereby acknowledge and consent to the following:

The facts set forth in this application are true and complete to the best of my knowledge. I understand that falsified statements in this application shall be considered sufficient cause to reject the application or to terminate appointment;
I understand Committee/Board Members are subject to the policies and procedures established by the County of Middlesex;
I understand appointed members are expected to attend all meetings of the Committee/Board;
All meetings are open to the public and membership is publicly appointed by the County of Middlesex Council based on qualified candidates selected from a publicly advertised notice of interest to serve;
Names of members appointed to the Committees/Boards will appear on publicly available agendas and minutes; and
If selected to be a member of a Committee/Board, I agree to abide by the rules of the Committee and attend meetings and events to the best of my ability and understand that absence from meetings pursuant to the policy or the terms of reference is grounds for my removal as a member of the Committee/Board.