Council Committee Member Application Form

First name:

Last Name:

Occupation:

Mailing address:

City:

Postal code:

Contact phone number:

Email:

What committee are you applying for?

Civic Recognition Awards Committee

Municipal Heritage Advisory Sub-Committee

Development Appeals Board

Economic Development Committee **When applying for this committee, please list any relevant business experience you may have below in the interest/contribution (500 words or less) section of this form

Environmental Committee

Recreation & Community Services Committee

Planning & Infrastructure Commission **Upon appointment to the Planning & Infrastructure Commission, a completed Public Disclosure Form is required of each member as per Section 116 of The Cities Act

Protective Services Committee

Yorkton Public Library Board/Parkland Regional Library Board

Please select all that apply:

I am a resident of the City of Yorkton

A Canadian Citizen

Full age of 18 years

Resided in the municipality, or on land now in the municipality, for at least 3 months; or

Is the owner of assessable land situated in the municipality, or of land now situated in the municipality, for at least 3 months; and

Has resided in Saskatchewan for at least 6 months

If you do not meet the above requirements, please specify:

Please describe why you are interested in sitting on this committee, and what you believe you can contribute (in 500 words or less):

I have reviewed the Council and Committee Code of Ethics

Yes

The City of Yorkton is committed to protecting your privacy. Personal information collected on this form is in accordance with The Local Authority Freedom of Information and Protection of Privacy Act (LAFOIP) and will only be used for the purpose for which it was collected. Personal information will not be shared or used for any other purpose without your express consent pursuant to LAFOIP and the City of Yorkton's policies. If you have any questions about the collection, use or disclosure of your personal information in this process, please contact the City Clerk for the City of Yorkton at 306‐786‐1717.

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Council Committee Member Application Form