Application for Appointment to a City of London Board or Commission

Note: Fields marked with ★ are mandatory.

Application

Please choose the Board or Commission you are interested in serving on:

Select an item Audit Committee Committee of Adjustment Court of Revision Covent Garden Market Eldon House London Police Services Board London Public Library London Transit Commission Middlesex-London Health Unit Board

Contact Information

Name

Address

City

Province

Select an item Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code

Phone Number

E-mail Address (A confirmation email will be sent to this address)

Experience and Qualifications

Have you previously served on a City of London Board or Commission? If yes, please provide the name of the Board or Commission, your dates of service and a brief description of your role.

Why are you interested in serving on this Board or Commission?

How would you contribute as a member of the Board or Commission? Please describe the skills, knowledge, experience, or expertise you would bring to the role.

Please describe your education, employment, volunteer or lived experience that would support your effectiveness in this role.

What do you believe are the key responsibilities of a Board or Commission member?

The City of London values Diversity, Inclusion and respect for all. Please describe what a commitment to diversity and inclusion means to you and how you have demonstrated these values through your experiences.

Please provide any additional information about yourself that you would like the Committee to consider in support of your application.

Confirmations

I declare the following:

• I am at least 18 years old.
• I am not a City of London employee or Council member.
• I acknowledge and understand that my application will be publicly available as part of the public agenda and official minutes that are published on the City of London website.

Please complete all sections before submitting. Attachments, including resumes, CVs or other supporting documents, will not be accepted.

To help inform our outreach activities, please tell us how you heard about this opportunity: (optional)

• City Website
• Social media (e.g. Facebook, Twitter)
• Contact from the City Clerk's Office
• Professional or community organization
• Conference or networking event
• Word of mouth
• Printed newspaper advertisement
• Other

If you selected 'Other', please specify

Submitter E-mail (In case we need to reach you regarding this submission)

The personal information on this form is collected under the authority of the Municipal Act, 2001 and will be used to assist the Municipal Council in selecting appointees for various City of London Boards, Commissions and Committees. Questions about this collection may be referred to the City Clerk, 300 Dufferin Avenue, London, ON; Tel: 519-661-2489 ext. 4937.

Note: If the form does not appear to submit, please open each section and confirm that there are no issues or missing required fields.

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