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Please check all applicable boxes.

By submitting this form you are consenting to the collection, storage, use and disclosure of your personal information. 

The City has the authority to collect, use and disclose your information for the purpose of the City’s statutory body 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.  

If you are applying to the Coquitlam Public Library Board, your personal information will be disclosed to the 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 a Board or Committee, your name will appear in minutes which are published on the Library’s and City’s websites. For questions or concerns about the collection of your personal information, please contact City Clerk's Office.

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.