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55+ Program Committee Application

Which Committee are you interested in applying for?

Applicant Information

First Name

Last Name

Address:

Phone Number:

Email Address:

Are you a Port Hope Resident or Rate Payer?

Yes

Are you at least 18 years of age?

Yes

Are you an employee of The Municipality of Port Hope?

Yes

Are you prohibited by law from voting in a municipal election?

Yes

Please explain why you would like to serve on this Committee/Board?

In detail, please explain your past experience, work related other other activities that illustrate the interest, skill sets or abilities you possess that would make you an ideal candidate?

Current Resume (not mandatory)

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References

By agreeing to this application, you authorize The Municipality of Port Hope to contact the following persons or organizations and authorize them to disclose to the Municipality any information required to assist in the evaluation of your application for the Commmittee/Bpoard.

First and Last Name

Phone Number:

Relationship to you

First and Last Name

Phone Number:

Relationship to you

First and Last Name

Phone Number:

Relationship to you

I agree that the information provided above is accurate and ready for review by the Municipality of Port Hope.

Yes

Date

Personal information contained on this form is collected under the authority of the Municipal Act, 2001 and the Corporation’s By-law No. 29/2013 and will be used to determine eligibility for the applicable license. Questions about this collection should be directed to the Corporate Services Department, 56 Queen Street, Port Hope ON L1A 3Z9 905-885-4544 or email us.

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55+ Program Committee Application

Applicant Information

References