Form Center

Complete only if you are not a resident of Coquitlam. Note that you will be required to provide evidence of the following if considered for appointment.

Please check all applicable boxes.

The City has the authority to collect, use and disclose your information for the purpose of the City’s statutory bodies application process in accordance with Section 26(c) of the Freedom of Information and Protection of Privacy Act.

Your personal information will be disclosed to a third-party service provider (i.e. website host CivicPlus) located in Canada for the purpose of processing your request.

Your personal information will be disclosed to Library staff and Board members for the purposes of reviewing applications and selecting candidates for interviews

Please also note that should you be appointed as a member of the Library Board, your name will be published on the Library website. For questions or concerns about the collection of your personal information, please contact the Legislative Services Manager, by email.

By checking the "I agree" box below, I certify that, to the best of my knowledge, the information provided is true and accurate.

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.