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WACCG Board of Management Nomination 2020.21
1.
Applicants Information
Full Name
Address (Home)
Address (Postal)
Email
Mobile
Alternative Phone
2.
Current Employer or Business Name
3.
If in business, please explain your business? If not, please explain your work experience.
4.
Please list Boards and Committees that you have/do work with? Your role and years of service.
5.
Please list any qualifications or training certificates (inc institute, date attained)
6.
Have you received any awards or honours that you’d like to mention?
7.
How do you feel your business/community would benefit from your involvement on the Board?
8.
How do you feel you indidivudally would benefit from your involvement on the Board?
9.
How do you feel WA Community Change Group would benefit from your involvement on the Board?
10.
Please rate yourself using a scale of 1 (Nil/Not Applicable) - 5 (High) to reflect the level of experience in each area listed.
Nil / Not Applicable
Low
Medium
Good
High
Industry Knowledge in Social Services
Nil / Not Applicable
Low
Medium
Good
High
Industry Knowledge in Mental Health
Nil / Not Applicable
Low
Medium
Good
High
Leadership Experience & Expertise in your field
Nil / Not Applicable
Low
Medium
Good
High
Legal Knowledge & Expertise
Nil / Not Applicable
Low
Medium
Good
High
Policy Development
Nil / Not Applicable
Low
Medium
Good
High
Marketing/PR
Nil / Not Applicable
Low
Medium
Good
High
Organisational Management
Nil / Not Applicable
Low
Medium
Good
High
Risk Management
Nil / Not Applicable
Low
Medium
Good
High
Strategic Planning
Nil / Not Applicable
Low
Medium
Good
High
Understanding Tendering/Grant submission process and impact
Nil / Not Applicable
Low
Medium
Good
High
Commercial Experience/Business Acumen
Nil / Not Applicable
Low
Medium
Good
High
Technology/IT Knowledge / Expertise
Nil / Not Applicable
Low
Medium
Good
High
11.
Please list any other relevant skills not covered below:
12.
Business / Committee Links: Please answer
Yes
Unsure
No
Other
Are you joining to access funding for your business/group?
Yes
Unsure
No
Other
Are you joining to gain support for your group/network?
Yes
Unsure
No
Other
Are you joining to support other businesses and community initiatives?
Yes
Unsure
No
Other
Are you joining to gain experience on a community Board of Management?
Yes
Unsure
No
Other
Are you joining to build your own professional networks?
Yes
Unsure
No
Other
Are you joining to gain industry experience?
Yes
Unsure
No
Other
Other (please specify)
13.
Please indicate:
Yes
No
Additional discussion required
Do you have a current National Police Clearance? (<2 mths)
Yes
No
Additional discussion required
Do you have a brief Resume you can provide
Yes
No
Additional discussion required
Have you ever been declared bankrupt?
Yes
No
Additional discussion required
Have you ever been banned from serving on a Board?
Yes
No
Additional discussion required
14.
Demographic Information
Gender
Age
Ethnicity
15.
Availability for Meetings (please note best days, times)
Current Progress,
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