Applications are due by 4:00pm on Friday December 7 2018. Upon request this form can be made available in alternate formats or with communication supports. To submit a request please contact the Clerk’s Office by phone at 613- 968-6481 or in person at City Hall, 169 Front St. Belleville ON K8N 2Y8

Application Form for Appointment to City of Belleville Boards, Committees, Special Committees, and Commissions

Indicate which board, committee, special committee, or commission you are applying for:

Accessibility Advisory Committee
Belleville Library Board
Belleville Youth Advisory Committee
Lighting Display Committee
Committee of Adjustment/Court of Revision/Property Standards/Fence Viewers
Cultural Exchange Committee
Façade Improvement Committee
Gerry Masterson Thurlow Community Centre
Glanmore National Historic Site Advisory
Green Task Force
Municipal Heritage Committee
Planning Advisory Committee
Police Services Board
Quinte Economic Development Commission
Stirling & District Recreation Centre
Transit Operations Advisory Committee
Traffic/Active Transportation Committee
Veridian Corporation
Applicant Information
Application Questions
Accessibility Advisory Committee Only

Under the Accessibility for Ontarians with Disabilities Act, 2005, the majority of members on an Accessibility Advisory Committee must be individuals with disabilities.

In order to ensure we can fulfill this requirement, we are asking that those who are comfortable please self-identify if you are an individual with a disability. (select one):

Yes, I am an individual with a disability
No, I am not an individual with a disability
Prefer not to answer

As much as possible, The City of Belleville is committed to ensuring our Accessibility Advisory Committee represents the diverse lived experiences of our community members.

Disclaimer

Personal information provided on this form is collected under than authority of the Municipal Act SO 2001, c 25 and may be made public during the appointment process. Please contact the City Clerk’s Department with any questions about the collection of this personal information: 613-968-6481 or at City Hall, 169 Front St. Belleville, ON K8N 2Y8.

I, the applicant listed above, certify that the information provided on this form is correct and I understand the collection and use of my personal information for the purpose of this application and appointment process.


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