The City of Moose Jaw encourages all interested citizens to review the purpose,
composition, qualifications, terms and meeting requirements for all boards, committees
and commissions prior to submitting an application.
- You must complete all sections except for the section marked "Self Declaration" which is
- Please complete a separate application for each Board, Committee or Commission for
which you wish to apply. You must attach a short (1-2 page) resume with each application.
- Applicants must be at least 16 years of age and be a current resident or owner of land in
the City of Moose Jaw.
- All applicants will be contacted by the City Clerks Office once City Council has made its
decision with respect to appointments to the City's Boards, Committees and Commissions.
Please indicate the Board, Committee or Commission for which you wish to apply.
A separate application for each Board, Committee or Commission for which you wish to apply is
Have you served on this board/committee/commission before? *
How did you hear about this opportunity?
Optional - Self-Declaration
The City of Moose Jaw strives towards having the membership of its boards, committees and
commissions reflect the diversity of Moose Jaw's population. Your answers to these questions
will be used for the purposes of measuring the composition of the City's boards, committees and
commissions and will guide decisions for future initiatives in working towards representation,
which reflects Moose Jaw's population. Please mark ail sections that apply to you.
In accordance with Section 24 of The Local Authority Freedom of Information and Protection of
Privacy Act, the personal information collected on this form will be used and disclosed solely for
purposes relating to the selection process for appointment to a Board, Commission or Committee
and for administration of the appropriate Board, Commission or Committee. If you have questions
relating to the collection and use of this information, please contact the City Clerk's Office at 306-
A person of First Nation or Metis ancestry.
A member of a visible minority group.
A person with a disability.
Voluntarily self-identify your age range in order to facilitate diverse representation of age groups on the City of Moose Jaw's boards, commissions, and committees.
By submitting this form, I confirm that:
• If selected to be a member of a board, committee or commission as the case may
be, I agree to abide by the rules of the board, committee or commission and attend
meetings to the best of my ability and understand that absence from meetings
pursuant to the policy or the terms of reference is grounds for my removal as a
member of the board, committee or commission.