Women in Mining Canada Board Member Application Candidate InformationPlease enter your contact informationName(Nécessaire) First Name Last Name Email address(Nécessaire) Email Confirmez l’adresse courriel Phone number(Nécessaire)Job title(Nécessaire) Company name(Nécessaire) City(Nécessaire)Please enter the city in which your are located Province(Nécessaire)Please enter the province in which you are located ApplicationPlease fill out the following section to submit your applicationPlease submit your CV(Nécessaire) Déposer les fichiers ici ou Sélectionnez des fichiers Taille maximum des fichiers : 256 MB, Nombre maximum de fichiers : 1. List any relevant board experience and specific duties, if applicable.(Nécessaire)Do you have any experience with fundraising, sponsorship, partnerships, etc? If so, please elaborate.(Nécessaire)Do you have any experience with board governance, legal matters, risk management, policy creation and contracts? If so, please elaborate.(Nécessaire)Do you have any experience in equity, diversity, inclusion and belonging in the Canadian mining industry? If so, please elaborate.(Nécessaire)Do you have any experience in event planning? If so, please elaborate.(Nécessaire)Women in Mining Canada is a working board. When considering your application, what is your expectation and capacity in volunteering hours? (Example: hours/month, hours/week, total hours, etc).(Nécessaire) Why would you like to be on the Women in Mining Canada Board?(Nécessaire)ReferencesPlease provide two referencesFirst reference name(Nécessaire) First Name Last Name First reference email address(Nécessaire) First reference phone number(Nécessaire)Second reference name(Nécessaire) First Name Last Name Second reference email address(Nécessaire) Second reference phone number(Nécessaire)DemographicsThis section is optional. This information will only be used for statistical purposes. Women in Mining Canada is committed to maintaining the confidentiality and security of the personal information in its custody or under its control.Consent I RECOGNIZE that Women in Mining Canada is committed to diversity and inclusion of its board of directors. This self-declaration form is used to indicate if I am member of one or more of the designated groups listed below. The collection of this information helps the Women in Mining Canada gather data and set targets to ensure diversity across its board of directors. My response to the self-declaration questions is voluntary and will be used for statistical purposes listed below. I CONSENT to the use, collection, disclosure and storage of my personal information by Women in Mining Canada for statistical reporting and analysis on the representation of diverse groups within Women in Mining Canada’s board of directors. The type of information that may be collected includes gender, ethnicity, age, indigenous status, career field and career level. I UNDERSTAND Women in Mining Canada will use reasonable efforts to ensure that my personal information is protected, including by implementing reasonable security safeguards appropriate to the sensitivity of the information. Women in Mining Canada will use industry-standard protocols and technology to protect my personal information and will ensure that access to my personal information is restricted to authorized personnel with a bona fide need to know such information. I agree I can review and amend the information collected about me (subject to any legal restrictions) by contacting Women in Mining Canada's privacy officer at the following address: info@wimcanada.org. Women in Mining Canada will retain my personal information only for as long as it is required for the purposes for which it was collected. Women in Mining Canada may keep my personal information even if I cease to be involved with Women in Mining Canada, if it is needed for the purposes of this Consent or where they are required by law to keep it. When my personal information is no longer required for the purposes listed in this Consent, Women in Mining Canada will delete, erase or make anonymous my personal information. I understand that I can withdraw this Consent at any time in the future by giving reasonable notice to Women in Mining Canada. For certainty, such withdrawal of consent does not affect Women in Mining Canada’s ability to use, collect or disclose personal information required or permitted by law or regulatory bodies. Any questions regarding this Consent or Women in Mining Canada’s collection, use or disclosure of personal information should be directed to Women in Mining Canada’s privacy officer at info@wimcanada.org.Gender Man Woman Non-binary Two-spirit Prefer not to identify Autre Ethnicity Asian Black Caucasian Indigenous Latinx Middle Eastern Mixed ethnicity South or Southeast Asian Prefer not to identify Autre Age <25 26-30 31-40 41-50 51+ Indigenous status First Nation Inuit Métis Prefer not to identify Not Indigenous Career field Communications Consulting Engineering Environment Finance Geosciences Human Resources Operations Recruitment Trades Autre Career level Student Entry-level Intermediate Mid-level Senior or executive-level Autre
