Nomination form

This form is to be completed by all carers or representatives of organisations that support carers, who wish to be considered for membership of the Queensland Carers Advisory Council.

Before completing this form, you should carefully read the information for applicants, including membership eligibility and responsibilities.

The Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships is committed to respecting, protecting and promoting human rights. Under the Human Rights Act 2019, the department has an obligation to act and make decisions in a way that is compatible with human rights and, when making a decision, to give proper consideration to human rights.

Nomination form

An asterisk (This field is required) indicates a required field.

Privacy statement

The Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships is collecting your information in accordance with the Carers (Recognition) Act 2008 for the purpose of assessing your application to be a member of the Queensland Carers Advisory Council.

Your information will be used to obtain criminal history, assess the suitability of appointment, or be used for administration of the Queensland Carers Advisory Council. Your information will be provided to a department selection panel, Queensland Police Service and to the Minister and Premier of Queensland. If successful, your name may be published in a media release (with your consent).

Your information will be managed by the Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships in accordance with the Information Privacy Act 2009.

Eligibility and role
Are you a current Queensland resident?You must be a resident of Queensland to be a member of the Council.This field is required

Sorry, you are not eligible. You must be a Queensland resident to be a member of the Council.

Please select the role you would like to be considered for:This field is required
Personal details of applicant
Residental address
Do any of the following descriptions apply to you?Select all that apply.
1st referee details

Please provide the contact details of a referee who has a thorough knowledge of your role as a carer, your involvement in the community, and/or who are able to provide a character reference. Please advise any nominated referees that we may contact them.

2nd referee details

Please provide the contact details of a second referee who has a thorough knowledge of your role as a carer, your involvement in the community, and/or who are able to provide a character reference. Please advise any nominated referees that we may contact them.

Employer agreement to participate

This part is only applicable for carers who are employed or organisational representatives.

Do you have approval from your employer (CEO, Chairperson or similar) to attend and participate in, council activities during business hours?
Experience
Are you a member on any other government bodies (e.g. committees, boards)?This field is required
Declaration
I declare that:All options must be selected.This field is required