Edmonton Public Library Board Application Form by QoA2W6h7


									                          EDMONTON PUBLIC LIBRARY BOARD
                        Board Member Application Form – 2013-14 Term
How did you learn             Examiner         Journal               Sun           Other Newspapers        Email
about Board Vacancy?          Radio            Television            Website       Word of Mouth           Other
Home Address:
Postal Code:                                           Length of Residence in Edmonton:

Contact Information Please indicate the preferred method of contact
(Home Ph)                    (Work Ph)                      (Cell)

Age Group:                     < 18                 18 - 30                    31 - 50           51 – 64                65 +

Have you reviewed the Edmonton Public Library Board Recruitment Profile and do you meet the eligibility

Why are you interested in serving as a member?

Please indicate how your background, skills, and perspective will assist this board.

What do you see as key library issues?

What experience do you have in serving on boards with governance responsibilities?

Do you have any real or perceived conflict of interest with serving on this board?

Is there any other information you would like to add for the selection committee’s consideration?

Applicants are required
to submit:                     Completed Application Form                 Resume         3 Letters of Reference*
NOTE: *References should be from individuals that can comment on the relevant qualities, skills or knowledge you possess

By checking this box I declare that the information provided in this application is correct and complete to the best of my
knowledge. I understand that false information given or any relevant information withheld will result in the denial of my

          (Name)                                                 (Date)

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This personal information is being collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act and
will be used throughout the recruitment process. If appointed to a civic agency, this information will be provided to the agency and kept on file
in the Office of the City Clerk during your term of appointment. It is protected by the privacy provisions of the Act. If you have any questions
about the collection contact Office of the City Clerk, 780-442-4395.

                        EDMONTON PUBLIC LIBRARY BOARD
                 Board Member Application Form – 2013-14 Term Page 2

                       Deadline for Applications is: Friday - SEPTEMBER 28, 2012
                          Return to: CITY OF EDMONTON, Office of the City Clerk
                 2nd Floor, Churchill Building, 10019 – 103 Avenue, Edmonton, AB T5J 0G9
                     FAX: 780-496-8175            E-MAIL: Civic.Agencies@edmonton.ca

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         Edmonton Public Library Board (Web Page – Mandate, Board Members & Contact
         Edmonton Public Library Board Recruitment Profile (Eligibility Requirements, Board
         Member Qualifications, Time Commitment and other Board Member details)

    Community Services Committee of Council serves as the Selection Committee for this Board.
    It is anticipated that selection processes will take place on the following dates:
                     o    October 23, 2012 – Applicant short listing
                              (Only short listed applicants are contacted at this time)
                     o    November 6, 2012 – Applicant Interviews
                     o    November 14, 2012 – Appointment made by City Council
                              (Notification by email to all applicants)
    In support of the City’s paperless strategy, correspondence with applicants will be by email.
    Short listed applicants will be asked to complete a   Citizen-At-Large Bio form, and brief
    biography will be made public by being included in the report to City Council, if appointed to
    this Board.

     Appointments to the Edmonton Public Library Board are for a 2-Year term.
    City of Edmonton Volunteer Management practices include an annual evaluation of
    Board Members. (City Policy C476C)

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