EXPRESSION OF INTEREST PUBLIC COMMITTEES, BOARDS AND COUNCILS

Transcription

1 EXPRESSION OF INTEREST PUBLIC COMMITTEES, BOARDS AND COUNCILS You may submit your Expression of Interest in the following ways: Complete the online form; or Complete the application form below and either it or print and mail it to: Registrar, Appointments Department of Executive Government of the Northwest Territories Box 1320 Yellowknife NT X1A 2L9 Phone: (867) ext Fax: (867) Expression of Interest will be retained on file for two years. Name: Full Mailing Address: Telephone: (Home) (Bus.) (Cell) Fax: Please select which public board do you wish to be considered for? You may apply to as many s as you wish. Aboriginal Languages Revitalization Apprenticeship, Trade and Occupation Certification Aurora College of Governors Beverly and Qamanirjuaq Caribou Management Dental Registration Committee Fort Smith Regional Wellness Council Gwich in Land and Water Gwich in Renewable Resources Agricultural Products Marketing Council Assessment Appeal Tribunal Beaufort Delta Regional Wellness Council Dehcho Regional Wellness Council Environmental Studies Management Gwich in Arbitration Panel Gwich in Land Use Planning Hay River Regional Wellness Council

2 International Porcupine Caribou Inuvialuit Environmental Impact Review Inuvialuit Water Judicial Council for Territorial Judges Legal Aid Commission of the Northwest Territories Mackenzie River Basin Mackenzie Valley Land and Water Mine Occupational Health and Safety Legislation Natural Resources Conservation Trust Fund of Trustees Northwest Territories Business Development and Investment Corporation Northwest Territories Health and Social Services Leadership Council Northwest Territories Power Corporation ( of Directors) Northwest Territories Social Assistance Appeal Official Languages Public Utilities of the Northwest Territories Sahtu Arbitration Panel Sahtu Land Use Planning Sahtu Renewable Resources Student Financial Assistance Appeal Tlicho Community Services Agency Waste Reduction and Recovery Advisory Committee Wek eezhii Renewable Resources Workers Compensation Appeals Tribunal Yellowknife Regional Wellness Council Inuvialuit Arbitration Inuvialuit Environmental Impact Screening Committee Judicial Appointments Advisory Committee Justices of the Peace Review Council Liquor Licensing Mackenzie Valley Environmental Impact Review Medical Registration Committee Mining Industry Advisory Committee Northwest Territories Arts Council Northwest Territories Egg Producers Northwest Territories Judicial Remuneration Commission Northwest Territories Review NWT Surface Rights Porcupine Caribou Management Safety Advisory Committee Sahtu Land and Water Sahtu Regional Wellness Council Status of Women Council of the Northwest Territories Territorial of Revision Victims Assistance Committee Wek eezhii Land and Water Wildlife Management Advisory Council (NWT) Workers Safety and Compensation Commission Governance Council

3 Are you a beneficiary or participant of an NWT Land Claim? If yes, are you a beneficiary or participant of? Acho Dene Kue First Nation Akaitcho Dene First Nation Dehcho First Nations Gwich in Final Agreement Inuvialuit Final Agreement K atl odeeche First Nation NWT Métis Nation Sahtu Final Agreement Salt River First Nation Tłįchǫ Agreement Current place of employment and position: Employment Background: Education:

4 Community/Committee Involvement: Previous Experience: Additional Information: Potential Conflict of Interest: Please provide details of any business or private, political interest or personal connections which might be relevant to the work of the concerned. These could include financial interests or share ownership, membership or societies, activities, associations or employment of a partner or friend in the particular field in which the public operates. Any potential conflicts of interest detailed here will not prevent your application being considered but may, if appropriate, be explored with you as part of the appointments process.

5 Personal Information Acknowledgement: I understand additional personal information may be required from me if I am a candidate who is considered for appointment. Personal information about me may be collected from the Government of the Northwest Territories and used to evaluate suitability as a candidate, as well as, to verify the truth and accuracy of the information provided, and for no other purpose. Agree Disagree Privacy Act Statement This information is being collected under the authority of the Access to Information and Protection of Privacy Act (ATIPP) The privacy provisions of ATIPP protect this information. Personal information is defined under ATIPP. All applicants have the right to examine and request correction of his or her records and to request a review by the Information and Privacy Commissioner. If you have any questions about the collection of information, contact: Information and Privacy Commissioner th Street PO Box 262 Yellowknife NT X1A 2N2 Phone (867) or toll free 1 (888) Submitted by: Date: