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1. Name (Required.)

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2. Phone number (Required.)

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3. Email address (Required.)

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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?

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9. What other Boards have you served on?

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10. Do you have a current resume or CV you are willing to share with us? If so, please upload it here.
You may email it to scassidy@clps.ca, if preferred.

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

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12. Can you regularly attend Board meetings?

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

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14. Are you available for day and evening meetings?

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

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16. Reference #1

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17. Reference #2

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18. Reference #3

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19. 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.

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

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20. Signature (please type your name if completing online)

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