Expression of Interest - Membership Of The Friends Of Aileu Community Committee

Privacy Statement:

The information requested on this form is being collected by Hume City Council (Council) for registering your Expression of Interest for membership on the Friends of Aileu Committee. This information will be used solely by Council for that primary purpose or a directly related purpose and managed in accordance with Privacy and Data Protection Act 2014. The applicant understands that the personal information provided is for that Expression of Interest and that they may apply to Council for access and/or amendment of the information in accordance with Council’s Information Privacy and Health Records Policy

1. Please indicate which position you are expressing interest in:Note: Positions are for a two-year term

2. Please provide your contact details: *This question is required.

First Name

Last Name

Mailing Address

Suburb

Postcode

Phone Number

Email Address

3. Please briefly outline your interest in nominating, and what skills and experience you feel you could bring to the committee: Please limit response to 200 words

4. Please briefly outline how you believe you can contribute to the achievement of the Purpose and Scope of the Committee and to fulfil the relevant Roles, Responsibilities and Accountabilities, as detailed in the Terms of Reference: Please limit response to 200 words

5. Please list any Reference Groups or Committees on which you have served during the last five years, including those supported by any local government authority:

Space Cell	Name of Reference Group or Committee	Period of Service (e.g. 2012 – 2017)
1.	1.: Name of Reference Group or Committee	1.: Period of Service (e.g. 2012 – 2017)
2.	2.: Name of Reference Group or Committee	2.: Period of Service (e.g. 2012 – 2017)
3.	3.: Name of Reference Group or Committee	3.: Period of Service (e.g. 2012 – 2017)
4.	4.: Name of Reference Group or Committee	4.: Period of Service (e.g. 2012 – 2017)
5.	5.: Name of Reference Group or Committee	5.: Period of Service (e.g. 2012 – 2017)