Personal details






Application details








Diversity information

Members of the community, including women, First Nations peoples, people of culturally diverse backgrounds, people with a disability and young people, are encouraged to apply for positions on NSW boards and committees.








Special requirements in relation to the committee



Skills


Experience


Knowledge




Referees

NSW Government agencies must conduct referee checks on people who apply for membership to boards and committees. Below, please provide details for 2 referees.

Referee 1





Referee 2





Authorisation and signature
  • I certify that my answers are true and complete to the best of my knowledge.
  • I approve the NSW Government undertaking the following checks as deemed appropriate for applications to this committee:
    • ASIC Banned and Disqualified search
    • ASIC Enforceable Undertakings Register search
    • Australian Financial Security Authority National Personal Insolvency Index search
    • NSW Police Force National Police Check
    • Office of the Children's Guardian Working with Children Check
  • I acknowledge that if I am approved for appointment or reappointment to the committee, that I will be required to declare my conflicts of interest.

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