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Brockville as seen from the Saint Lawrence River on the east side of the downtown
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Volunteer Application Form

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For Volunteer Positions with the City of Brockville, Brockville Arts Centre, Brockville Museum and Brockville Public Library.

Applicant Information

New or Returning Volunteer(Required)
Please check one Position / Board applying for:(Required)
Applicant Name(Required)
Address(Required)
Preferred method of contact:(Required)
Emergency Contact
English
French
Other
Morning
Afternoon
Evening
Time of Year(Required)

I authorize the Corporation of the City of Brockville to contact the persons or organizations listed below for the purpose of obtaining reference information. Relatives are not accepted for reference purposes.

Name(Required)
Name(Required)
Name(Required)

The following portion pertains to those applying for Boards and Committee ONLY.

Are you the owner or tenant or the spouse of an owner or tenant of land in the City of Brockville?
Are you 18 years of age or older?
Have you included your mandatory Criminal Record Check? :
Are you legally entitled to work in Canada?

Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) is collected under the authority of the Municipal Act, 2011, and in accordance with the provisions of the MFIPPA. Personal information on this form will be used to assess the applicant’s eligibility for volunteer positions or qualifications for appointment to one of the various committees or boards. At no time will your personal information be disclosed without your express written consent. Questions regarding the collection, use and disclosure of this personal information may be directed to the Freedom of Information Coordinator, Clerk’s Office, 1 King Street West, Brockville, ON K6V 7A5, 613-342-8772.

Declaration: I hereby declare that the foregoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from volunteering, or may cause my dismissal from volunteering.

MM slash DD slash YYYY

Thank you for considering volunteering with the City of Brockville.

Volunteer Application Forms are kept on file for six months from date of receipt.

Please complete and return by mail or email

City of Brockville

1 King Street, West

P.O. Box 5000

Brockville, ON K6V 7A5

clerk@brockville.com

613-342-8772

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Enter the verification code that was sent to you.