Application for Stakeholder Appointment to the Oshawa Animal Care Advisory Committee

This form is for Stakeholder Organization Appointments Only.

Voluntary Diversity Information (Confidential)

City Council recognizes that the City of Oshawa is best serviced by Advisory Committees and local boards which generally reflect the diversity of our community.

You are encouraged to complete this voluntary, confidential diversity questionaire. The information gathered will be used for the purpose of enabling the City to achieve its objectives of access, equity and diversity. The information provided will not be released for any other purpose without your permission.

City Clerk Services will publicly report on the self-identified diversity data in summary form, but will keep the identities of specific candidates confidential. This will assist with the City's future diversity objectives and decide what improvements can be made such as targeted outreach or removing barriers to participation.

City Clerk Services collects this information in compliance with provisions of the Municipal Freedom of Information and Protection of Privacy act and Ontario Human Rights Code.

Indigenous Peoples: A person is indigenous if the person is a member of the First Nations, Inuitor Metis peoples of Canada

Disability: A person with a disability has an ongoing physical, mental, sensory or learning impairment, which may rsult in experiencing disadvantage or barriers to full participation in society.

Ethnicity/Race: Ethnic/rachial groups are defined by race or colour only, not by country of birth, citizenship or religious affiliation. Please identify whoch of the following best describes your ethnicity or race

Sexual Orientation: LGBTTIQQ2S is an abreviation used to represent a borad array of identities such as but not limited to, lesbian, gay, bisexual, transsexual, transgender, intersex, queer, questioning and two-spirited.

*Declaration (please read carefully)

Information provided in this application for appointment is treated confidentially. Review all the information you have provided since it will be used to determine your suitability for appointment. Sign and date the declaration below. Note you are required to attach a resume to your application. If you are applying as a nominee or a corporate member, you must include a letter of nomination from the corporate member that also confirms you are an officer or director of such corporation. Thank you for your interest in appointment with the City of Oshawa. 

I certify that the statements made by me are true and complete to the best of my knowsledge. I understand that any misrepresentation made by me in connection with this application will be sufficient cause for rejection of this application. I authorize investigation of all statements contained in this application, and release from liability any person or company furnishing such information.

I understand and agree that the personal information contained within this form will be disclosed to members of Oshawa City Council at their request, at any time during the term of any appointment made as a result of this application.

This form may contain personal information as defined under the Municipal Freedom of Information and Protection of Privacy Act. This information is collected under the legal authority of the Municipal Act, 2001, S.O. 2001 c.25, as amended. This information will be used and maintained by the City of Oshawa to determine suitability for appointment to a local board or committee and will be disclosed to members of Oshawa City Council. Questions regarding this collection may be directed to the City’s Information Access and Privacy Officer at 905-436-3311.