Required fields are marked with asterisks (*)

Committee Application Form

All information collected on the committee membership application form is subject to the Freedom of Information and Protection of Privacy Act (FIPPA). Information collected on the application form will be maintained by the City as required by FIPPA for the purpose of administering the Council Committee System Policy. By completing and submitting an application form, you are agreeing to this lawful collection of information by the City.

Should you have any questions or concerns about the collection of your personal information, please contact the Information and Privacy Coordinator at 604-469-4571 or foi@portmoody.ca.

Please note that per the Council Committee System Policy section 1.2.7, a person is limited to serve on one committee or board at a time. Should you be appointed as a member of a committee or board; your name will appear in the minutes which are published on the City of Port Moody website. Meetings are held electronically through Zoom and will be required to follow the City’s Electronic Meeting Participation Requirements Policy.

Contact Information

First name:

Last name:

What are your pronouns? (ex: she/her, he/him, they/them, etc.)

Preferred name (If different from the first name you provided)

Do you live in Port Moody?

Yes

Address:

Postal code:

Email:

Phone:

From time to time, it may be required for the Committee Chair, Committee members, or staff to communicate with you directly via email for purposes related to your position and work as an active Committee member. For this reason, we ask you for consent to your contact information (email address) being disclosed to the Committee Chair, Committee members, or staff on an as-needed basis for the purpose of conducting Committee-related business only.

The City’s collection, use, and disclosure of your personal information is authorized by, and in accordance with the Freedom of Information and Protection of Privacy Act. If you have any questions regarding the collection, use, and disclosure of your personal information, please contact the City’s Privacy Officer at: foi@portmoody.ca

Do you consent to your contact information (email address) being disclosed to the Committee Chair, Committee members, or staff on an as-needed basis for the purpose of conducting Committee-related business only?

Yes

For the next question please review the Terms of Reference and meeting schedule for each Committee here to assess your suitability and availability for your preferred committee.

Which Committee are you applying to?

Youth Focus Committee

In case you are not selected for your primary Committee choice, please review all existing vacancies and select the top alternative Committees that you would be interested in being a member of (select up to two only)

Arts, Culture, and Heritage Committee

Climate Action Committee

Economic Development and Tourism Committee

Inclusion, Diversity, Equity, and Accessibility (IDEA) Committee

Parks and Environment Committee

Seniors Focus Committee

Transportation Committee

None

Please provide a brief statement on why you would like to be on the Committee you have chosen, including any skills or experience that are suited to the position.

Do you have a unique perspective that you would bring to the Committee?

If you are not selected for a committee during this round of recruitment, would you like to be considered and contacted if new opportunities arise throughout the year? If yes, your information and contact details will be retained until the end of the upcoming committee year.

Would you like to be considered and contacted if new opportunities arise throughout the year?

Yes

Do you have any specific accessibility needs or other support requirements?

Yes

How did you hear about this opportunity? (Please check all applicable boxes)

City website

Social Media

Friend/Family

Community Bulletin Board

Digital Billboard

Mailed Postcard

Other

Please read the Code of Conduct for Advisory Bodies and complete the following member statement. Note: This is mandatory, and your application will not be accepted without acknowledgement and agreement to this statement.

ADVISORY BODY MEMBER STATEMENT
As an appointed member to a City of Port Moody Advisory Body of Council, I agree to uphold the code of ethics adopted by the City and to conduct myself by the following model of excellence:

I will:
- Recognize the diversity of backgrounds, interests, and views in our community.
- Help create an atmosphere of open and responsive government.
- Conduct public affairs with integrity and in a fair, honest, and open manner.
- Respect other members and the unique role and contribution each of us has in making the City of Port Moody a better place to work and live.
- Strive to keep the decision-making processes open, accessible, participatory, understandable, timely, just, and fair.
- Avoid and discourage conduct which is not in the best interest of the City of Port Moody.
- Treat all people with whom I come into contact in the way in which I would wish to be treated.
I affirm that I have read and understood the City of Port Moody code of ethics.

I agree to the Advisory Body Member Statement above

Agree