Discipline Committee Application Form

Instructions
Please send your completed application form and two letters of support by email to nominations@thebao.ca or by mail to the BAO, Attention: Governance & Nominations Committee, 100 Sheppard Ave East, Suite 505, Toronto, Ontario, M2N 6N5.
Part 1 - Contact Information
Salutation*
- Mr.
- Ms.
- Mrs.
- Miss
- Dr.
- Other
Custom Salutation*
First Name*
Last Name*
Preferred Name*
Example: Andrew aka Andy – Normand aka Norm
E-mail Address*
Preferred contact phone number*
Home Address
Home Address*
Unit / Apt #
City*
Province*
Postal Code*
Country*
- Preferred mailing address box
Occupation and Business Address
Company Name*
Occupation Title*
Business Address*
Unit / Apt #
City*
Province*
Postal Code*
Country*
P.O. Box
- Preferred mailing address box

Part 2
Committee to which you are applying
(Check all that apply)
- Appeal Committee
Part 3
Membership classification*
(Check all that apply)
- Consumer representative (no past or current affiliation to bereavement profession)
- Cemetery Operator
- Crematorium Operator
- Funeral Establishment Operator - Class 1 Funeral Director Funeral Establishment
- Operator - Class 2 Funeral Director

Part 4 – Qualifications
Keeping in mind the mandate of the BAO committees, please tell us how your background, skills, and experience will result in useful contributions. Please be brief where possible (point form is okay) and share the information you think is most relevant to the Bereavement Authority of Ontario.
A. Your interest in this position
Please tell us about your interest in serving on a BAO Committee. Why are you interested in this particular committee? What do you want to contribute as a committee member?
B. Education and Training Background
Please tell us about your educational background (e.g. courses, degrees, diplomas, or certificates), professional credentials, or any other training gained through professional and personal development that is relevant to the committee position.
C. Professional and Employment Background
Please describe any current or past work experiences and skills that are relevant to this committee position, including positions held and your responsibilities and accomplishments.
D. Memberships, Community and Volunteer Activities
Tell us about any current or past memberships with professional associations /organizations, community involvement, or volunteer work that you believe to be relevant to the committee position you are applying for. Please describe the role you played and the period of time you were involved.
E. Additional Information
Please share any additional skills, bilingualism (French and English), experiences, or information about yourself that relates to the committee position.

Part 5 – Privacy and Consent Statement
By selecting "I agree," and by signing below, you declare that the information in this application form is true and understand that :
- You may be asked to provide photo identification, a criminal background check, additional references, or other information to confirm your identity, eligibility, and qualifications;
- The personal information requested on this application form is being collected and used by the Bereavement Authority of Ontario to evaluate the suitability of all potential candidates.
- The qualifications of intended appointees will be subject to a review by the Governance & Nominations Committee.
- Additional personal information may be required from you if you are a candidate who is considered for appointment.
- Personal information about you may also be collected from the organizations or from the references who provided support letters for you, and used to evaluate your suitability as a candidate, as well as to verify the truth and accuracy of the information you have provided, and for no other purposes.
- This information will not be disclosed except as required for the above noted purpose.
- You may be asked to participate in a phone or virtual interview.
- Any questions about the collection, use or disclosure of personal information collected on this form, should be directed to nominations@thebao.ca
Consent*
- I agree*

Part 6 – Eligibility
For bereavement sector members, only candidates and operators in good standing are eligible for appointment. By selecting "I agree," you declare that the information in this application form is true and understand that:
- Operators or licensees who have been the subject of a Proposal to Revoke are not eligible to serve on the Discipline Committee unless the proposal has been rescinded, or a Court or Tribunal has directed the Registrar not to carry out the Proposal.
- Current and former Directors of the BAO Board of Directors, or former Board of Funeral Services cannot be committee members.
- Members shall not serve as a member of both the Discipline Committee and the Appeal Committee concurrently.
Consent*
- I agree*
Signature*
Name*
Date*
MM slash DD slash YYYY

Part 7 - Supporting Documents
Resumé and Reference Letters
Drop files here or
Accepted file types: doc, docx, pdf, ppt, pptx, Max. file size: 240 MB.

Instructions

Part 1 - Contact Information

Home Address

Occupation and Business Address

Part 2

Part 3

Part 4 – Qualifications

Part 5 – Privacy and Consent Statement

Part 6 – Eligibility

Part 7 - Supporting Documents