Contact Details

First name *

Surname *

Address

Suburb

Postcode

Phone

Business Phone

Email *

Please Indicate your Interest *

• Chair
• Independent Member
• Both

Application for Chair, or Chair and Independent Member (both)

High level of professional skill and experience (including qualifications) (required)

Leadership qualities (required)

High Level Communication Skills (required)

Proven ability to promote positive working relationships in a diverse range of Council functional areas (required)

Sound understanding and demonstrated knowledge of principles of good organisational governance, public sector accountability, financial reporting, internal audit operations and risk management principles (required)

High level of financial and business literacy (required)

Skills and experience across the following areas - local government/public sector, internal audit and external audit, risk management, governance, performance management, financial management and reporting, accounting, human resources management, internal control frameworks, fraud and corruption prevention, IT/cyber security and the local community (required)

Please outline your current and / or previous experience on similar committees (required)

Application for Independent Member Only

Professional Qualifications (required)

High level of financial and business literacy (required)

Skills and experience across the following areas - local government/public sector, internal audit and external audit, risk management, governance, performance management, financial management and reporting, accounting, human resources management, internal control frameworks, fraud and corruption prevention, IT/cyber security and the local community (required)

Mandatory Independence Criteria Questions

Are you currently a councillor of any NSW council? *

• Yes
• No

Are you currently a non-voting representative of the board of a join organisation? *

• Yes
• No

Were you a candidate at the last election of Council? *

• Yes
• No

Have you held office in Council during its previous term? *

• Yes
• No

Are you currently employed by Council or a joint organisation, or been employed during the last 12 months? *

• Yes
• No

Do you conduct audits of Council on behalf of the Audit Office of NSW? *

• Yes
• No

Do you have a close personal or business relationship with a Councillor or a person who has a senior role in Council that may lead to a real or perceived conflict of interest? *

• Yes
• No

Have you currently, or within the last three years, provided any material goods or services (including consultancy, legal, internal audit and advisory services) to Council which directly affects subjects or issues considered by the Audit, Risk and Improvement Committee? *

• Yes
• No

Do you have (or have a close family member who is) a substantial shareholder, owner, officer or employee of a company that has a material business, contractual relationship, direct financial interest or material indirect financial interest with Council or a related entity which could be considered a real or perceived conflict of interest? *

• Yes
• No

Are you currently or have you previously acted as an advocate of a material interest on behalf of Council or a related entity which could be considered a real or perceived conflict of interest? *

• Yes
• No

Referee 1

First Name - (Referee 1) *

Surname * (Referee 1)

Organisation * (Referee 1)

Referee's Position Held * (Referee 1)

Referee's Relationship with Applicant * (Referee 1)

Email * (Referee 1)

Contact Number * (Referee 1)

Alternative Contact Number (Referee 1)

Referee 2

First Name - (Referee 2) *

Surname * (Referee 2)

Organisation * (Referee 2)

Referee's Position Held * (Referee 2)

Referee's Relationship with Applicant * (Referee 2)

Email * (Referee 2)

Contact Number * (Referee 2)

Alternative Contact Number (Referee 2)

Uploads

Please attach your covering letter * Only pdf and word documents are accepted. File size must not exceed than 4 MB.

Please attach your resume * Only pdf and word documents are accepted. File size must not exceed than 4 MB.

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Council is bound by the provisions of the Privacy and Personal Information Protection Act 1998, in the collection, storage and utilisation of personal information provided in this form. Accordingly, the personal information will only be utilised for the purposes for which it has been obtained and may be available for public access and/or disclosure under various NSW Government legislation.