Application to the Board of Directors

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* 1. Name

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* 2. Phone number

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* 3. Email address

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* 4. Address

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* 5. Occupation

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* 6. What is your interest in Community Living Parry Sound?

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* 7. Please provide a brief bio, including a bit of your background (examples can be found here)

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* 8. What skills would you contribute to our Board?

Business

Children's services

Cultural diversity

Fundraising

Governance

Health care

Human Resources

Legal

Lived experience - family advocate

Lived experience - self-advocate

Property management

Public relations/media

Seniors' services

Social work

Other (please specify)

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* 9. What other Boards have you served on?

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* 10. Are you willing to commit to a three-year term?

Yes

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* 11. Can you regularly attend Board meetings?

Yes

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* 12. Can you commit to one Board and one Committee meeting per month and complete preparation work?

Yes

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* 13. Are you available for day and evening meetings?

Yes

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* 14. Has any member of your immediate family worked at Community Living Parry Sound in the past two years?

Yes

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* 15. Reference #1

Name

Phone number

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* 16. Reference #2

Name

Phone number

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* 17. Reference #3

Name

Phone number

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* 18. Reference Check Release
This gives us permission to speak with your references.

I authorize Community Living Parry Sound to check my references and verify my credentials by conferring with the persons and entities identified in my application, including on my resumé and in interviews as applicable.

I understand that the purpose of this information exchange is to verify my references and credentials, and ultimately for the purpose of determining my suitability for membership on Community Living Parry Sound’s Board of Directors.

I authorize the references named on my application to provide Community Living Parry Sound with any information relevant to my performance and/or verification of my credentials.

I hereby release any entities that provide this information from any claim or liability for any damage whatsoever which I could or might claim because of such disclosure. I also authorize the investigation of all statements made in my application and interview.

I understand and agree

I do not understand and/or agree

A criminal reference check is required and will be coordinated by Community Living Parry Sound.

Application to the Board of Directors

Question Title

* 1. Name

Question Title

* 2. Phone number

Question Title

* 3. Email address

Question Title

* 4. Address

Question Title

* 5. Occupation

Question Title

* 6. What is your interest in Community Living Parry Sound?

Question Title

* 7. Please provide a brief bio, including a bit of your background (examples can be found here)

Question Title

* 8. What skills would you contribute to our Board?

Question Title

* 9. What other Boards have you served on?

Question Title

* 10. Are you willing to commit to a three-year term?

Question Title

* 11. Can you regularly attend Board meetings?

Question Title

* 12. Can you commit to one Board and one Committee meeting per month and complete preparation work?

Question Title

* 13. Are you available for day and evening meetings?

Question Title

* 14. Has any member of your immediate family worked at Community Living Parry Sound in the past two years?

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* 15. Reference #1

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* 16. Reference #2

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* 17. Reference #3

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* 19. Signature (please type your name if completing online)