Halton Region Online Self-Service

The following application form is a fillable HTML form. If you require the form in another format, please contact the Regional Clerk.

Please select a Board:

Please note: if you do not submit your application within 60 minutes, the form will expire and your data will be lost.

Citizen application for

I am a person with a disability:

Yes

Personal information:

Name: (required)

Pronouns:

Address: (required)

City/Town: (required)

Postal code: (required)

Email: (required)

Confirm Email: (required)

Residential phone number:

Business phone number:

Voluntary Self-Identification:

Halton Region is committed to supporting, enabling and advancing equity, diversity and inclusion in the workplace and community. The purpose of the voluntary self-identification is to assist Halton Region in ensuring balanced membership from underrepresented groups as much as possible on its committees and other bodies. Please indicate all that apply of the following designated group(s) with which you wish to be self-identified. If you do not wish to answer, please select ‘I choose not to self-identify’.

Women

Indigenous Peoples (First Nation, Inuit or Métis)

Racialized Individuals

Black (African, Caribbean, Americas)

East Asian

Latin American

Middle Eastern

South Asian

Southeast Asian

Mixed Race

Another race category (please specify)

Please specify

Persons with Disabilities (A disability can include a broad range and degree of permanent and temporary conditions, some visible and some not. A disability can be present from birth, caused by an accident or develop over time and can include a physical, sensory, intellectual, learning or mental health condition.)

Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer (2SLGBTQ+)

I do not identify with any of the groups listed above

I choose not to self-identify

Voluntary Self-Identification

Relevant Experience:

1) Please outline the reason(s) you are applying to this specific Committee/Board/Agency and how you feel you can contribute to its work:

2) Please outline your previous involvement with committees, boards, agencies or community activities in the past five years:

3) Employment experience in the last five years:

4) Academic qualifications:

3) Please provide any additional relevant information:

Supporting Documentation:

Hidden Maximum File size


References:
Name:	Phone number:
Name:	Phone number:
Name:	Phone number:

Consent and Acknowledgement:

I confirm that I meet the membership requirements and/or qualifications for the Regional Waterfront Parks Advisory Committee

I am a person living with a disability.

(A disability can include a broad range and degree of permanent and temporary conditions, some visible and some not. A disability can be present from birth, caused by an accident or develop over time and can include a physical, sensory, intellectual, learning or mental health condition.)

By submitting this application form, I hereby request consideration for appointment to the Halton Region Accessibility Advisory Committee and I understand that my name, but not my personal data, will be considered public information and may be released upon request.

I confirm that I am eligible to serve on the Halton Police Board as I am not currently a judge, justice of the peace, police officer or person who practices criminal law as a defence counsel.

Personal information provided in and attached to this application is collected pursuant to section 11 of the Municipal Act, 2001, S.O. 2001, c.25. and will be used by the Interview Committee to determine eligibility for appointment. Contact information of successful applicants may be shared with the staff liaison and other staff members directly involved in administration and may also be used for the purpose of advising of relevant Halton Region issues or events.

Questions about the collection of your information should be directed to:

Regional Clerk

1151 Bronte Road,

Oakville, Ontario L6M 3L1

Phone: 905-825-6000

Toll Free 1-866-442-5866

Email: regionalclerk@halton.ca