WACCG Board of Management Nomination 2020.21

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* 1. Applicants Information

Full Name

Address (Home)

Address (Postal)

Email

Mobile

Alternative Phone

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* 2. Current Employer or Business Name

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* 3. If in business, please explain your business? If not, please explain your work experience.

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* 4. Please list Boards and Committees that you have/do work with? Your role and years of service.

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* 5. Please list any qualifications or training certificates (inc institute, date attained)

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* 6. Have you received any awards or honours that you’d like to mention?

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* 7. How do you feel your business/community would benefit from your involvement on the Board?

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* 8. How do you feel you indidivudally would benefit from your involvement on the Board?

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* 9. How do you feel WA Community Change Group would benefit from your involvement on the Board?

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* 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	Industry Knowledge in Social Services Nil / Not Applicable	Industry Knowledge in Social Services Low	Industry Knowledge in Social Services Medium	Industry Knowledge in Social Services Good	Industry Knowledge in Social Services High
Industry Knowledge in Mental Health	Industry Knowledge in Mental Health Nil / Not Applicable	Industry Knowledge in Mental Health Low	Industry Knowledge in Mental Health Medium	Industry Knowledge in Mental Health Good	Industry Knowledge in Mental Health High
Leadership Experience & Expertise in your field	Leadership Experience & Expertise in your field Nil / Not Applicable	Leadership Experience & Expertise in your field Low	Leadership Experience & Expertise in your field Medium	Leadership Experience & Expertise in your field Good	Leadership Experience & Expertise in your field High
Legal Knowledge & Expertise	Legal Knowledge & Expertise Nil / Not Applicable	Legal Knowledge & Expertise Low	Legal Knowledge & Expertise Medium	Legal Knowledge & Expertise Good	Legal Knowledge & Expertise High
Policy Development	Policy Development Nil / Not Applicable	Policy Development Low	Policy Development Medium	Policy Development Good	Policy Development High
Marketing/PR	Marketing/PR Nil / Not Applicable	Marketing/PR Low	Marketing/PR Medium	Marketing/PR Good	Marketing/PR High
Organisational Management	Organisational Management Nil / Not Applicable	Organisational Management Low	Organisational Management Medium	Organisational Management Good	Organisational Management High
Risk Management	Risk Management Nil / Not Applicable	Risk Management Low	Risk Management Medium	Risk Management Good	Risk Management High
Strategic Planning	Strategic Planning Nil / Not Applicable	Strategic Planning Low	Strategic Planning Medium	Strategic Planning Good	Strategic Planning High
Understanding Tendering/Grant submission process and impact	Understanding Tendering/Grant submission process and impact Nil / Not Applicable	Understanding Tendering/Grant submission process and impact Low	Understanding Tendering/Grant submission process and impact Medium	Understanding Tendering/Grant submission process and impact Good	Understanding Tendering/Grant submission process and impact High
Commercial Experience/Business Acumen	Commercial Experience/Business Acumen Nil / Not Applicable	Commercial Experience/Business Acumen Low	Commercial Experience/Business Acumen Medium	Commercial Experience/Business Acumen Good	Commercial Experience/Business Acumen High
Technology/IT Knowledge / Expertise	Technology/IT Knowledge / Expertise Nil / Not Applicable	Technology/IT Knowledge / Expertise Low	Technology/IT Knowledge / Expertise Medium	Technology/IT Knowledge / Expertise Good	Technology/IT Knowledge / Expertise High

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* 11. Please list any other relevant skills not covered below:

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* 12. Business / Committee Links: Please answer

	Yes	Unsure	No	Other
Are you joining to access funding for your business/group?	Are you joining to access funding for your business/group? Yes	Are you joining to access funding for your business/group? Unsure	Are you joining to access funding for your business/group? No	Are you joining to access funding for your business/group? Other
Are you joining to gain support for your group/network?	Are you joining to gain support for your group/network? Yes	Are you joining to gain support for your group/network? Unsure	Are you joining to gain support for your group/network? No	Are you joining to gain support for your group/network? Other
Are you joining to support other businesses and community initiatives?	Are you joining to support other businesses and community initiatives? Yes	Are you joining to support other businesses and community initiatives? Unsure	Are you joining to support other businesses and community initiatives? No	Are you joining to support other businesses and community initiatives? Other
Are you joining to gain experience on a community Board of Management?	Are you joining to gain experience on a community Board of Management? Yes	Are you joining to gain experience on a community Board of Management? Unsure	Are you joining to gain experience on a community Board of Management? No	Are you joining to gain experience on a community Board of Management? Other
Are you joining to build your own professional networks?	Are you joining to build your own professional networks? Yes	Are you joining to build your own professional networks? Unsure	Are you joining to build your own professional networks? No	Are you joining to build your own professional networks? Other
Are you joining to gain industry experience?	Are you joining to gain industry experience? Yes	Are you joining to gain industry experience? Unsure	Are you joining to gain industry experience? No	Are you joining to gain industry experience? Other

Other (please specify)

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* 13. Please indicate:

	Yes	No	Additional discussion required
Do you have a current National Police Clearance? (<2 mths)	Do you have a current National Police Clearance? (<2 mths) Yes	Do you have a current National Police Clearance? (<2 mths) No	Do you have a current National Police Clearance? (<2 mths) Additional discussion required
Do you have a brief Resume you can provide	Do you have a brief Resume you can provide Yes	Do you have a brief Resume you can provide No	Do you have a brief Resume you can provide Additional discussion required
Have you ever been declared bankrupt?	Have you ever been declared bankrupt? Yes	Have you ever been declared bankrupt? No	Have you ever been declared bankrupt? Additional discussion required
Have you ever been banned from serving on a Board?	Have you ever been banned from serving on a Board? Yes	Have you ever been banned from serving on a Board? No	Have you ever been banned from serving on a Board? Additional discussion required

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* 14. Demographic Information

Gender

Age

Ethnicity

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* 15. Availability for Meetings (please note best days, times)