Personal details

Full name

Date of birth

Residential address

Postal address

Contact phone

Special requirements in relation to the committee

Please tick any of the below boxes that describe your academic, work or lived experiences and can be supported via a referee report or your resume.

Identify as First Nations and/or representative of First Nations community, group or peoplesCommunity interest (benefits or impacts)Wetland or floodplain property holder and/or land managerEnvironmental science interest and/or knowledgeWaterway operator or water user groupConservation group representativeOther

Describe your experience

Add supporting information

Skills

Please tick any of the boxes below that describe your skills.

I can think objectively about a problemI can understand complex information and argumentsI can support an inclusive and collaborative approach I can remain respectful during robust debateI can listen to and absorb other points of view, and clearly state my own positionI understand and can manage my conflicts of interestI can effectively communicate within and between my community to the Environmental Water Advisory Group

Please provide an example of when you have demonstrated at least one of the above skills you have selected.

Experience

Please tick any of the boxes below that describe your experience.

I have previous liaison or representative experienceI have been part of a team that worked for a common goalI have been part of complex decision making or consensus decision makingI have previously been to Environmental Water Advisory Group meetings (as a member or otherwise), or been on other committeesI have experience in negotiation or conflict mediation

Please provide an example of how at least one of the above skills you have selected will assist you as an Environmental Water Advisory Group member.

Knowledge

Please tick any of the boxes below that describe your knowledge.

I understand the role of water in local and regional communities and their environmentsI have some understanding of how regulated water is managed in NSW, including some understanding of how the Australian Government's Murray Darling Basin Plan applies to NSWI understand the objectives and limitations of the advisory group

Please provide a short explanation of your knowledge in at least one of the above skill areas you have selected.

Why do you want to be an Environmental Water Advisory Group committee member?

How do you think your skills and experience can contribute to the committee?

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

Name

Position

How does this person know you?

Contact phone

Contact email

Referee 2

Name

Position

How does this person know you?

Contact phone

Contact email

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.

Signature

Type your full name

Date