Qld Register of Nominees

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The Qld Register of Nominees to Government Bodies

Registers and Boards

Conditions of Use:
Before completing this online application form, you are encouraged to familiarise yourself with the Conditions of Use of the form.

Personal Details (please print)
* indicates required field

Title:
Given Names*:
Surname*:
Address*:
Postcode*:
Phone:	(b/h) (a/h) (m)
Email:
Gender*:	Male Female
Age range (optional):	under 15 15-17 18-25 26-34 35-44 45-54 55-64 65 and over
Applicants under the age of 18 require the written consent of their parent or adult guardian to be included in the Register. Please use the hard copy registration form to apply if you are not yet 18.

Experience / Areas of Interest

Please nominate a maximum of four areas of experience/interest from the following occupational categories:

	Accounting / Economics / Finance
	Arts / Crafts
	Built Environment / Construction

	Business / Commerce

	Carer

	Communications / Marketing
	Community Service / Welfare

	Consumer Protection
	Education

	Employment / Industrial Relations

	Environment / Conservation
	Government

	Multicultural Affairs
	Indigenous Affairs

	Information Technology / Telecommunications
	Law

	Management

	Medicine / Health

	Media

	Natural Resources

	Primary Industries

	Police / Security / Corrective Services
	Science

	Sport / Recreation

	Student

	Tourism / Hospitality
	Trade

	Transport

	Youth Affairs

	Other:

Qualifications/Professional Registrations:

Demographic Information

Region *:

Target Group Information

Please indicate if you identify as a member of any of the following groups. Provision of this information is optional, but will assist in searching for target group representation.

	Aboriginal
	Torres Strait Islander
	Australian South Sea Islander
	Person aged 18-25
	Person with a disability
	Person from a non-English speaking background please specify ethnicity:
	Person with knowledge of and expertise in multiculturalism
	Person with proficiency in language/s other than English please specify:

Government agencies forward information about services and events from time to time. Please indicate if you wish to receive information from any of the following:

Multicultural Affairs Queensland
Office for Women
Office of Youth
Department of the Premier and Cabinet

Please indicate if you wish to be considered for non-Queensland Government board appointments and consent to your curriculum vitae being forwarded for these purposes:

Yes No

Attach CV:

Or you can post your CV to:
Queensland Register,
Executive Services,
Department of the Premier and Cabinet,
PO Box 15185,
CITY EAST QLD 4002,
Or fax your CV to:
(07) 3329 7494

Declaration

I certify that the information contained on this form and in my curriculum vitae is true and correct.

I understand that the lodgement of this form does not guarantee my appointment to Queensland Government bodies.

I understand that the information contained on this form and in my curriculum vitae will be entered into the Queensland Register of Nominees to Government Bodies.

I authorise the reproduction of my curriculum vitae and the release of such reproductions or the information contained in my application to Government agencies for the purposes of providing nominations to Government bodies and to non-government agencies if I have indicated my approval on the registration form.

I understand that failure to respond to a request for updated personal details and curriculum vitae will result in my registration lapsing.

I certify that I am 18 or over 18 years of age.

I Agree