2016 QTA Industry Award Nomination Form

2021 QTA Industry Award Nomination Form
Nominations Extended - Closing date 30 JULY 2021

A new Nomination Form must be completed for each Award Category
Industry Award Category*

Trucking Woman of the Year AwardProfessional Driver of the Year AwardIndustry Excellence AwardTraining & Skilling Excellence AwardYoung Achiever of the Year Award (30 years or younger at 3 July 2021)Industry Safety & Innovation Award
Additional Information Required

Nominations need to be accompanied by supporting information and documentation as per the relevant Award Selection Criteria.

Please check the award criteria to determine additional documentation required to support your nomination and ensure you upload the documents or email them to admin@qta.com.au
Young Achiever Award - Age at 3rd July 2021
Complete this question only if you are nominating someone for the Young Achiever Award
Full details of two (2) Referees, including telephone numbers are required as these persons may be contacted.
Referee One Details*
Referee Two Details*

Nominee Details (Individual Nominees)

Enter the details of the individual you are nominating for the award
Surname*
First Name*
Mobile Number*
Phone Number
Email*
Home Address
Suburb
State
Postcode
Company*
Company Address*
Company Address Suburb*
Company Address State*
Company Address Postcode*

Nominee Details (Company Nominees)

Enter the details of the company you are nominating for the award
Company*
Company Address*
Suburb*
State*
Postcode*

Proposer's Details

Enter your details or that of the person putting forward the nomination
Surname*
First Name*
Mobile Number*
Phone Number*
Email*
Company*
Company Address*
Suburb*
State*
Postcode*
Proposer's position in company*
Company Director's Name*
Upload your supporting documents*

Upload a File
Check the awards criteria to ensure you include all required documentation Cancelof
I certify that the information entered is true and correct*

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2021 QTA Industry Award Nomination Form