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    Preferred Title*


    I, the undersigned, hereby apply to be considered for appointment as a Director of the Corporation, and in doing so, acknowledge and declare that: (please check each statement below to indicate your acknowledgement

    *Family Member means the spouse, parent, child, brother or sister of any person, and the spouse of any such child,parent, brother or sister and includes the Partner of any person.

    Review of Director’s Responsibilities*
    Download Schedule A here

    I confirm that I have reviewed Schedule “A” to this Application and agree that, if I am appointed as a Director of the Corporation, I: (please check each statement below to indicate your acknowledgement)

    Skills, Experience & Knowledge*

    The Corporation supports a skills based Board of Directors. The skills, experience and knowledge of each applicant are considered in the recruitment process. In addition, candidate attributes are considered that reflect the breadth, depth and diversity of the Grey and Bruce communities served by the Corporation. To assist the Corporation in establishing a Board that meets these objectives, please complete the following.

    a) I have the skills or experience in the following areas: (please check all that apply)


    Conflict of Interest*


    If my application is approved, I agree to act as a Director of the Corporation and, in my capacity as a Director of the Corporation, I shall at all times act honestly and in good faith, in the best interest of the Corporation and abide by the Corporation’s By-Laws and all governing legislation. I understand that the term that I may serve as a Director is to be determined. I fully understand that any errors in my application may result in my application for consideration as a Director being refused or my Directorship being revoked. I undertake to advise the Corporation immediately in writing of any change in the information contained in this Application.

    I understand it is the policy of the Corporation to conduct reference and criminal background checks as part of the selection process. Permission is hereby given to the Corporation to investigate the references provided and conduct a background check.

    Acknowledgment of statement above*:

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