Community Member Application

Applicant Information

If other, please specify

Last Name

First Name

Neighbourhood

Contact Information

Address

City

Province

Postal Code

Phone - Residence

Phone - Business

Phone - Cell

Current Occupation

Employer

Confidential Voluntary Diversity Information (Optional)

The City of New Westminster has a core value of inclusion and recognizes that the City is best served by Commissions, Committees, and Boards which reflect the diversity of the community. You are encouraged to complete this confidential diversity questionnaire. This information is used to help the City in achieving and measuring its objectives for access, equity, and diversity. The Legislative Services Department will report on the results of these responses in summary form only and will keep all information confidential.

Other information

Commission/Committee/Board Relevant Information

Please indicate up to three Commissions, Committees, or Boards that you wish to be considered for (in order of preference):

First (or only) choice:

Second choice:

Third choice:

Please indicate the specialized role* (other than Community Member) that you wish to be considered for on any of the above-listed Commissions, Committees, or Boards:

* For more information on the specialized roles, please consult the Vacancies List and Terms of Reference for the specific Commission, Committee or Board.

Attach Résumé

Have you previously been a member of an advisory body to Council for the City of New Westminster?

Yes No

If yes, which Committee(s) and year(s)?

What skills and goals will you bring to the Commission/Committee/Board?

Please provide a brief summary of your work and educational background of the past five years:

Please indicate your community and volunteer activities of the past five years:

To help inform our outreach activities, please indicate how you heard about this opportunity (check as many as apply):

If other, please specify:

Consent

I consent to the release of the information on my application and understand that it will be made available on an as needed basis to New Westminster City Council, City staff and New Westminster Public Library staff, if applicable, for the sole purpose of making appointments to Commissions, Committees, or Boards, and, if I am appointed, for contacting me regarding meetings and sending information.

Date

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Note: This information is collected by the City of New Westminster under Section 26(c) of the Freedom of Information and Protection of Privacy Act and will be used to process and manage your Community Member Application. Should you have any questions about the collection of this personal information please contact the Freedom of Information & Privacy Coordinator, 511 Royal Avenue, New Westminster, V3L 1H9, 604-515-3828.

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