BAO’s Consumer Advisory Council Application Form - Bereavement Authority of Ontario

Instructions

Complete this form and submit it with a résumé, CV or plain-language summary of relevant experience and a brief statement of interest or cover letter. Alternate formats and assistance are available on request.

Part 1 – Applicant Information

Full name*

Preferred name

Municipality / community*

Postal code (first three characters only)*

(A1A)

Telephone*

Email*

Preferred contact method*

Telephone

Preferred language for communication*

English

French

Other

Specify preferred language for communication*

Accommodation or alternate-format request*

Yes

If yes, the BAO will contact you privately.

Voluntary Self-Identification

The BAO is committed to an inclusive Consumer Advisory Council that reflects a range of communities, identities, experiences and perspectives. The following questions are voluntary and are intended to help the BAO understand the overall diversity of the applicant pool and consider the collective composition of the Council.

Your responses will not be used to determine whether you meet the eligibility requirements or to assess your individual qualifications. You may select “Prefer not to answer” for any question. Information will be handled in accordance with the BAO Privacy Notice and will only be accessible to individuals authorized to support the recruitment and appointment process.

What is your age range?

18-34

35-49

50-64

65+

Prefer not to answer

What is your gender identity?

Cisgender Man

Cisgender Woman

Trans Man

Trans Woman

Non-Binary

Prefer not to answer

How do you identify in terms of ethnicity or Indigenous identity?

Indigenous (e.g. First Nation, Métis, Inuk/Inuit)

Black (e.g. African, Afro-Caribbean, African-Canadian descent)

East Asian (e.g. Chinese, Korean, Japanese, Taiwanese)

Southeast Asian (e.g. Thai, Vietnamese, Cambodian, Indonesian, Malaysian, Filipino)

South Asian (e.g. Indian, Pakistani, Sri Lankan, Bangladeshi)

Latino (Latin American, Hispanic descent)

Middle Eastern (e.g. Arab, Persian, West Asian descent)

White (European descent)

Prefer to self-describe

Prefer not to answer

Indigenous identity (optional)

Other Southeast Asian descent (optional)

Other South Asian descent (optional)

How do you identify in terms of ethnicity or Indigenous identity? (optional)

Do you identify as a person with a disability?

Yes

Prefer not to answer

Do you identify as a member of the 2SLGBTQIA+ community?

Yes

Prefer not to answer

Part 2 – Eligibility

Are you at least 18 years old?*

Yes

Do you reside in Ontario?*

Yes

Can you prepare for and attend a minimum of two Council meetings per year, with additional meetings as required?*

Yes

Will you comply with confidentiality, conflict-of-interest and conduct requirements?*

Yes

Part 3 – Application Questions

1. Why are you interested in serving on the BAO Consumer Advisory Council?*

2. What lived, community, consumer, advocacy or other relevant experiences and perspectives would you bring?*

3. How would you contribute to discussions involving different consumer needs and viewpoints?*

4. Describe an example of how you considered an issue beyond your own experience or helped identify a barrier affecting consumers.*

5. What support or meeting practices would help you participate effectively?*

Part 4 – Independence and Conflict Disclosure

Are you currently an owner, officer, director, senior employee or registered representative of an organization regulated by the BAO?*

Yes

If yes, please explain below.

Please explain your role with the BAO-regulated organization.*

Do you have any other actual, potential or perceived conflict, including a current or former sector connection, that could affect or appear to affect your independence?*

Yes

If yes, please explain below.

Please explain the actual, potential or perceived conflict.*

Disclosure does not automatically disqualify an applicant unless the connection is inconsistent with the approved eligibility requirements. The BAO may request additional information to assess and manage a conflict.

Part 5 – Supporting Documents and Referral Source

Please attach both of the following:

Résumé, CV or plain-language summary of relevant experience
Statement of interest or cover letter

Résumé / CV / experience summary and statement of interest / cover letter*

Drop files here or

Accepted file types: pdf, doc, docx, rtf, txt, Max. file size: 10 MB, Max. files: 5.

You may upload up to 5 files (PDF, DOC, DOCX, RTF or TXT, max 10 MB each).

How did you hear about this opportunity?

Part 6 – Applicant Declaration

I confirm that the information provided is accurate to the best of my knowledge. I have reviewed the Privacy Notice and understand that the BAO will collect, use and retain my personal information to administer the Consumer Advisory Council recruitment and appointment process. I understand that appointment is subject to eligibility, assessment, due diligence and Board approval.

Declaration*

I confirm and agree to the declaration above.

Signature*

Typed name or electronic submission may be accepted as confirmation where authorized by the BAO.

Date*

MM slash DD slash YYYY