The Corporation of the Town of Whitby Office of The Town Clerk 575 Rossland Road East Whitby, ON L1N 2M8 www.whitby.ca Phone: 905.430.4315 Fax: 905.686.7005 Email: clerk@whitby.ca

Application for Appointment to the WhitbyPublic Library Board

Applicant Last Name First Name

Address Unit No. City/Town Postal Code _____________________________________________________________________________ Email Address Business Phone No. Home Phone No.

Whitby Resident ☐Yes ☐ No

Whitby Property Owner ☐Yes ☐ No

Whitby Business Owner ☐Yes ☐ No

Are you 18 years of age or older? ☐ Yes ☐ No

Are you able to attend daytime or evening meetings as required? ☐Yes ☐ No

Questionnaire 1. Describe your familiarity with the Whitby Public Library.

2. What do you see as the role of the Library Board?

3. Why are you interested in serving on the Whitby Public Library Board?

4. Please describe any experience you have with Boards and Committees in the areas of:

• Governance • Strategic Planning• Policy • Advocacy and Community Development• Financial Management • Risk Management

5. What other skills and interests do you have that you feel would be useful to the WhitbyPublic Library Board?

Resume 6. To complete your application we highly recommend that you attach a resume and/or cover

letter.Resume attached ☐Yes ☐ No

Certification I hereby certify that the information contained in this application form is accurate.

______________________________________________________________________________ Date Signature

Office Use Only ______________________________________________________________________________ Date Application # Committee Town Clerk Review

The personal information on this form is collected under the authority of the Municipal Act, 2001. The information is used to assess an applicant’s eligibility to serve on a Town of Whitby Board or Committee. Questions about this collection can be directed to: Town Clerk, 575 Rossland Road East, Whitby, ON L1N 2M8 or by telephone at 905.430.4315.