Required fields are marked with asterisks (*)

Application for Appointment to the Oshawa Accessibility Advisory Committee

Requirements

I am a person with a disability

Yes

Please Describe:

I am familiar with issues affecting people with disabilities

Yes

First Name:

Last Name:

Address:

Apartment/Suite/Unit:

City:

Postal Code:

Telephone:

TTY

Email Address:

Education

(list any of the following achievements - attach additional pages if required)

Do you have any licenses or certificates that relate to this application?

Have you taken any courses that relate to this application?

Check here if additional information or a resume will be attached

Yes

Describe any of your work related skill, activities, experience or training that relate to the appointment being applied for:

List your involvement (if any) with disability organizations and/or associations including any Board of Directors experience.

Describe why you are seeking appointment to the Accessibility Advisory Committee.

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 for 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.

Gender

Female

Male

Transgender

Other

Age

18-24

25-34

35-44

45-54

55-64

65+

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

Based on this description, do you consider yourself to be an Indigenous person?

Yes

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

Based on this description, do you consider yourself to be a person with a disability?

Yes

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

Please identify which of the following best describes your ethnicity or race

Black (e.g. origins include Canadian, American, Caribbean, African)

Central and South American (e.g. origins include Canadian, Mexican, Brazillian, Cuban, Chilean, El Salvadorian)

East Asian (e.g. origins include Canadian, Japanese, Korean, Chinese)

Pacific Islands (e.g. origins include Canadian, Fijian, Hawaiian, Polynesian, Samoan)

South Asian (e.g. origins include Canadian, Indian, Pakistani, Bangladeshi, Sri-Lankan, Caribbean, African)

South-East Asian (e.g. origins include Canadian, Vietnamese, Filipino, Malaysian, Indonesian, Cambodian, Thai)

West Asian or Arab (e.g. origins include Canadian, North African, Armenian, Egyptian, Iranian)

White or Caucasian (e.g. origins include Canadian, American, Western or Eastern European)

Any other non-white racial group not identified above (e.g.multiple racial origins, Aboriginal Peoples of the Pacific Islands, South or Central American)

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

Based on this description, do you consider yourself LGBTTQQ2S?

Yes

Additional Diversity Information: You are welcome to provide any additional diversity information not captured by the questions above (e.g. ethno-cultural, faith, linguistic)

*Declaration

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

I Agree to the Terms of this Application

Yes

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 for to determine suitability for appointment to a local board or committee and disclosed to members of Oshawa City Council. Questions regarding this collection may be directed to the City’s Information Access and Privacy Officer, City of Oshawa, 50 Centre Street South, Oshawa, Ontario, L1H 3Z7 at 905-436-3311.

Form Builder

Application for Appointment to the Oshawa Accessibility Advisory Committee

Requirements

Education

Voluntary Diversity Information (Confidential)