volunteer package

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

www.iccrc-crcic.ca

CONTACTINFORMATION FirstName:

LastName:

PreferredTelephoneNumber:

EmailAddress:

MailingAddress:

City:

Province: PostalCode:____________

ICCRCMembershipNumber: ImmigrationConsultantSince:____________

COMMITTEEPOSITIONBEINGAPPLIEDFOR(1st,2nd,3rdPreferences) Appeal GovernanceandNominating

CommunicationsandOutreach HumanResourcesandCompensation

Complaints PracticeManagementandEducation

Discipline RegistrationandMembership

FinanceandAudit Review

Transparency

Pleaseexplainwhatexperienceyouhaverelatingtothecommitteesyouhavechosen.

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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COMMITTEEEXPERIENCECommitteeExperience(1)

NameofCompany/Organization:

From(dd/mm/yyyy): to(dd/mm/yyyy):

PositionHeld:

CommitteeExperience(2)NameofCompany/Organization:

From(dd/mm/yyyy): to(dd/mm/yyyy):

PositionHeld:

Didyoucompleteallyourterms? Yes No

Ifno,pleaseexplain.

VOLUNTEER,COMMUNITY,PROFESSIONALANDNOT-FOR-PROFITACTIVITIESPleaseprovideabriefdescriptionofvolunteeractivitiesfromthelastten(10)yearsforyourcommunity,professionalassociation(s),charity,andnot-for-profitsthatwouldberelevantforthepositionyouhaveappliedfor.WORKEXPERIENCE;EDUCATION;PROFESSIONALDEVELOPMENTPleaseattachacurrentrésuméoutliningyourhistoryofworkexperience,education,andcontinuingprofessionaldevelopment. Resumereceived: Yes No

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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REFERENCESPleaseprovidethenamesandcontactinformationoftwo(2)referencestovalidateyourCommitteeandWorkExperience.Reference1: Name:

Telephonenumber:

Emailaddress:

Natureofrelationship:

Reference2: Name:

Telephonenumber:

Emailaddress:

Natureofrelationship:

ExtensiveKnowledgeThroughExperience Communications: PublicRelations: Education: RegulatoryAffairs: FinancialLiteracy: RiskManagement:

GovernanceLeadership: OrganizationalPerformance:

HRCompensation: StrategicAnalysis:

LegalKnowledge: InformationTechnology:Whichoneoftheseskillsisyourstrongest?

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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GENERALQUESTIONSWhydoyouwanttobeamemberofaparticularICCRCCommittee?BACKGROUNDCHECKANDOTHERFORMSPleasecompletetheBackgroundCheckConsentFormorifamemberingoodstandingofICCRC,pleaseprovide thefollowingandsendtotheattentionof:DaceStripnieks,eitherbyemailatdstripnieks@iccrc-crcic.caorbyregularmail.

1. CurrentResume2. Self-DeclarationofEligibilityForm3. ConfidentialityandNon-DisclosureAgreement4. CompletedApplicationforNewMembersofaCommittee

Pleasesubmityoursignature: Name:

Date:

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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DECLARATIONOFELIGIBILITYTOSERVEASAVOLUNTEERONTHEBOARDOFDIRECTORSORA

COMMITTEEOFTHEBOARD

I, R declarethat: Name MembershipNumberIam:

1. aMemberingoodstandingwithICCRC;2. IamaCanadiancitizen,permanentresident,orStatusIndianresidingin3. eighteenormoreyearsofage;and

Iamnot:

4. bankruptorhavebeendeclaredinsolventasdefinedbytheBankruptcyandInsolvencyAct(Canada);

5. mentally incompetentorbecomeofunsoundmindthatwouldcausemenot tobeable

tofulfilmyresponsibilitiestoICCRC;6. one convicted of any criminal offence; regulatory or similar offence which the Board

determines in its sole discretion would render me unfit or inappropriate to act as adirectorormemberofanICCRCCommittee;

7. dealingwithanypendingor outstanding legal challengesarisingoutofmy involvement

inorbusinesswithimmigrationconsultancyoranyothermatterthatmightcompromiseICCRC;

8. a full-time or part-time employee of ICCRC or an affiliated organization or any other

regulatory professional body in immigration consultancy; unless the Board in its solediscretiondeterminesthatthereisnoapparentconflictofinterest;

9. and no immediate family member is a member of the Board of Directors, or of any

committeeof any other organization orwithwhich ICCRC conducts businesswith or isassociated withor any other regulatory body; unless the Board in its sole discretiondeterminesthatthereisnoapparentconflictofinterest;

10. andmyimmediatefamilyarenotamemberofanyofthefollowingCommitteesofICCRC:

(i) AppealCommittee(ii) CommunicationsandOutreachCommittee(iii) ComplaintsCommittee(iv) DisciplineCommittee(v) FinanceandAuditCommittee(vi) GovernanceandNominatingCommittee

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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(vii) HumanResourcesandCompensationCommittee(viii) PracticeManagementandEducationCommittee(ix) Registration&MembershipCommittee(x) ReviewCommittee;(xi) TransparencyCommittee

11. subject to a final determination of guilt in respect of any charge laid against suchmembersofICCRCpursuanttothebylawsandadjudicatedbytheDisciplineCommittee,theAppealCommitteeoranyappellatecourtortribunalhavingjurisdictionwithallrightsofappealshavingbeenexhaustedorwaived;or

IfurthercertifythatIabidebyallofICCRC’sapplicablebylawsandregulations.I also certify that the informationprovided in thedocuments submitted to ICCRC relating tomy20__[insertyear]BoardofDirectorsandCommitteeApplicationaretrueandaccurate.Exceptions: (pleaseprovidedetails)Signedinthepresenceof

SignatureofWitness SignatureofDeclarant

PrintNameofWitness ICCRCMember#

AddressofWitness

TelephoneofWitness

EmailAddressofWitness

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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CONFIDENTIALITYAGREEMENT

TO: IMMIGRATIONCONSULTANTSOFCANADAREGULATORYCOUNCIL

(“ICCRC”)

5500NorthServiceRd.,Suite1002,Burlington,ONL7L6W6FROM: (the"Recipient")

LegalName

LegalAddress("Recipient")hasormay,fromtimetotime,beprovidedaccesstocertainconfidentialandproprietaryInformationofICCRC,includingwithoutlimitingthegeneralityoftheforegoing,computerprograms,reports,plans,analyses,forecastsorotherinformation(collectively,the"Information").TheRecipienthasrequestedthatICCRCfurnishitwiththeInformation."InconsiderationofthedisclosureoftheInformationbyICCRCtoRecipient,Recipientagreesasfollows:

1. TheInformationshallbeprovidedbyICCRCtoRecipientatICCRC'ssolediscretionandshallbetreatedasconfidentialbyRecipientandRecipientshallnot,eitherdirectlyorindirectly,disclose,allowaccessto,transmitortransfertheInformationtoanythirdpartywithoutthepriorwrittenconsentofICCRC

2. RecipientshallnotusetheInformationinanymannerexceptasreasonablyrequiredin

connectionwith(the"Purpose").

3. RecipientshalldisclosetheInformationonlytothoseofitsemployeeswhohaveaneedtoknowtheInformationforthePurpose.Recipientshall,priortodisclosingtheInformationtosuchemployees,issueappropriateinstructionstothemtosatisfyitsobligationshereinandobtaintheiragreement,intheformhereof,orsuchotherformasICCRCmayfromtimetotimerequire,toreceiveandusetheInformationonaconfidentialbasisonthesameconditionsascontainedinthisAgreement.WhenrequestedbyICCRC,Recipientwillpromptlyprovidealistcontainingthefullname,title,locationandfunctionofeachemployeehavingaccesstoorcopiesoftheInformation.RecipientshallbefullyresponsibletoensurethateachsuchemployeehandlestheInformationasrequiredbythisAgreement,andRecipientshallbeliableforanylossordamageresultingfromanysuchemployeefailingtodoso.RecipientshallnotifyICCRCpromptlyofanyunauthorizeduseorpossessionoftheInformationthatcomestoRecipient'sattention.

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

©2015 IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

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4. TheInformationshallnotbecopied,reproducedinanyformorstoredinaretrievalsystemordatabasebyRecipientwithoutthepriorwrittenconsentofICCRC.AllcopiesshallcontainthesameproprietarynoticesofICCRCwhichmayappearontheoriginalInformation.

5. Notwithstandingtheforegoing,RecipientshallnotberequiredtomaintaintheconfidentialityofanyInformation:

a. whichRecipientcanestablish,bydocumentedandcompetentevidence,wasinthepossessionofRecipientpriortothedateofdisclosurethereofbyICCRC;

b. whichRecipientcanestablish,bydocumentedandcompetentevidence,wasrightfullyobtainedbyRecipientfromathirdpartynotunderanyobligationofconfidentialitytoICCRC;

c. whichRecipientcanestablish,bydocumentedandcompetentevidence,wasdevelopedbyRecipientindependentlyoftheInformationreceivedfromICCRC;

d. whichRecipientcanestablish,bydocumentedandcompetentevidence,istobedisclosedpursuanttothelawfulrequirementofagovernmentalagencyororderofacourtofcompetentjurisdictionorbyoperationoflaw,providedthatsuchdisclosureissubjecttoallapplicablegovernmentalorjudicialprotectionswhichmaybeavailable;or

e. whichwaspartofthepublicdomainatthetimeofdisclosureorthereafterbecomespartofthepublicdomainthroughnoactorfailuretoactonthepartoftheRecipient(butonlyafteritentersthepublicdomain).

6. IntheeventthatRecipientisrequestedpursuantto,orrequiredby,applicablelaw,regulation

orlegalprocesstodiscloseanyoftheInformation,RecipientwillnotifyICCRCpromptlysothatICCRCmayseekaprotectiveorderorotherappropriateremedyor,initssolediscretion,waivecompliancewiththetermsofthisAgreement.Intheeventthatnosuchprotectiveorderorotherremedyisobtained,orthatICCRCwaivescompliancewiththetermsofthisAgreement,RecipientwillfurnishonlythatportionoftheInformationwhichRecipientisadvisedbycounselislegallyrequiredandwillexerciseallreasonableeffortstoobtainreliableassurancethatconfidentialtreatmentwillbeaccordedtheInformation.

7. RecipientacknowledgesthatICCRCdoesnotmakeanyexpressedorimplied

representationorwarrantyastotheaccuracyorcompletenessoftheInformation,andRecipientagreesthatICCRCwillnothaveanyliabilityrelatingtotheInformationorforanyerrorsthereinoromissionstherefrom.

8. ICCRCshallatitsdiscretionprovidesuchoftheInformationtotheRecipientasisrequiredfor

thePurpose.NothinginthisAgreementobligatesICCRCtomakeanyparticulardisclosureofInformation.

9. Allright,titleandinterestinandtotheInformationshallremaintheexclusivepropertyofICCRC

andtheInformationshallbeheldintrustandconfidencebytheRecipientforICCRC.Nointerest,licenceoranyrightrespectingtheInformation,otherthanexpresslysetoutherein,isgrantedtotheRecipientunderthisAgreementbyimplicationorotherwise.

10. DuetothevaluableandproprietarynatureoftheInformationtoICCRC,theobligationsassumedbytheRecipienthereundershallbeunlimitedintimeorterritory.Ifanyprovisionofthisagreementisheldtobeinvalidorunenforceableinwholeorinpart,suchinvalidityorunenforceabilityshallattachonlytosuchprovisionorpartthereofandtheremainingpartofsuchprovisionandallotherprovisionshereofshallcontinueinfullforceandeffect.

APPLICATIONFORNEWMEMBERSOFACOMMITTEE 2015-001

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11. ThisAgreementconstitutestheentireagreementbetweenthepartiesheretowithrespecttothesubjectmatterhereofandsupersedesanypriorunderstandingsandagreementsbetweenthepartiesheretowithrespectthereto.Therearenorepresentations,warranties,terms,covenants,conditionsorcollateralagreements,express,impliedorstatutorybetweenthepartiesotherthanasexpresslysetforthinthisAgreement.

12. ThisAgreementmaynotbeassignedbyeitherpartywithoutthepriorwrittenconsentofthe

otherparty.ThisAgreementshallensuretothebenefitofandbebindingupontherespectiveheirs,executors,administrators,successorsandpermittedassignsofthepartieshereto.

13. Recipientshall,uponrequestofICCRC,immediatelyreturntoICCRCtheInformationandall

copiesthereofinanyformwhatsoeverunderthepowerorcontrolofRecipientordestroysameasdirectedbyICCRCandfurnishtoICCRCacertificate(byanofficerofRecipientifitisacorporation)ofsuchdestruction.

14. RecipientacknowledgesthatabreachofthisAgreementmayresultinirreparableand

immediateharmtoICCRCandagreesthatintheeventofsuchbreachICCRC,inadditiontoanyotherrightorrelief,shallbeentitledtoequitablereliefbywayoftemporaryorpermanentinjunctionandtoseeksuchotherreliefthatanycourtmaydeemjustandproper.

15. ThisAgreementshallbeconstruedinaccordancewithandshallbegovernedbythelawsofthe

ProvinceofOntario,CanadaandthelawsofCanadaapplicabletherein.ForthepurposeofalllegalproceedingsthisAgreementshallbedeemedtohavebeenperformedintheProvinceofOntarioandthecourtsoftheProvinceofOntarioshallhavejurisdictiontoentertainanyactionarisingunderthisAgreement.RecipientherebyattornstothejurisdictionofthecourtsoftheProvinceofOntario.

Theundersignedherebyagreestobeboundbytheforegoingtermsandconditions.

DATEDthe ________________dayof____________________,20__.

By:Name:Title: