Board Member Application

Board Member Application
Employment Information
Volunteer Information
Application Summary

Personal Information

Given Name

Surname

Date of Birth

Home Address

City

Postal Code

Email Address

Contact Telephone Number

Employment Information

Employed By

Job Title

Business Address

Business Contact Number

Business Fax Number

Business Email Address

If you have a Curriculum Vitae or Resume please attach it below Choose a file

Max. size: 32.0 MB

Volunteer Information

Referred by: (Board Member(s):

Please list the names of any volunteer organizations you are/or have been a member of:

1st Organization & Position Held

2nd Organization & Position Held

3rd Organization & Position Held

About Section

Why are you interested in Crime Stoppers and how do you feel you can contribute?

List any special interests, skills or hobbies you have:

If yes, please explain:

Additional Information Section:

PLEASE READ THE FOLLOWING BEFORE SIGNING

I understand that my application will be discussed by the present members of the Brant-Brantford Crime Stoppers Board of Directors. I authorize the Brantford Police Service and/or Ontario Provincial Police to obtain the information they may have concerning any convictions or criminal offenses relating to me and to divulge any such information to the Brant-Brantford Crime Stoppers board. If accepted I would be willing to take an Oath of Secrecy and maintain the confidentiality of all Crime Stoppers information. I understand that if I am accepted to the Board I will be required to attend all Board of Directors meetings and Working Committee meetings in accordance with the governing bylaws as set by Brant-Brantford Crime Stoppers. I agree to actively participate in fundraising ventures for the program if the Board accepts me.

I HAVE READ THE ABOVE AND AGREE TO ABIDE WITH THE CONDITIONS AS SET OUT THEREIN:

Virtual Signature - Full Name:

Date: