Committee Membership Expression of Interest Form

Committee Membership Expression of Interest Form

Thank you for expressing your interest in volunteering for a Council Committee. This form can be used for two purposes – to apply for membership to a Council Committee during the formal open membership period, and for expressing interest in joining an existing Committee at any time. Membership to Committees outside of the formal open membership period is subject to membership vacancies.
PRIVACY STATEMENT:
We will handle any personal information you have provided in this form in accordance with the Privacy and Data Protection Act 2014. Our privacy policy contains information about how you may access your personal information and seek correction of such information; as well as how to complain about a breach of the Australian Privacy Principles and how we will deal with such a complaint. For more information, please see our Privacy Policy or contact our team on (03) 5391 4444. Your personal information will not be disclosed to any other party unless Council is required to do so by law, has gained your consent to do so or an information privacy principle exemption applies.
Your Contact Details
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

TownState

Post Code
Your Emergency Contact Details
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.

Eligibility

All Committees	Nominees must be able to commit to attend 80% of meetings as well as additional volunteer hours to deliver Committee activities as required
All Advisory Committees	Nominees must work, study or reside in the town(or district surrounding the town) and must be committed to the purpose of the Committee
Hindmarsh Pride Committee	Have knowledge and udnerstanding of the needs and issues relevant to the LGBTIQ+ community; Have the capacity to analyse information and provide advice on issues affecting the LGBTIQ+ community; and Have willingness and ability to engage in open and respectful discussions that add value to the Reference Group and liveability of the Hindmarsh LGBTIQ+ community
Asset Committee	Be committed to the purpose of the Committee and to promoting accessible and inclusive use of the relevant facility.

Please describe how you meet the eligibility criteria for the Committee you wish to join and what you will bring to the committee:*

Volunteer Requirements (please tick to show you have read and understand each requirement)*

I understand that I am responsible for my own health and safety and the health and safety of those affected by my work when I am volunteering. I commit to undertaking my volunteer role in a safe manner and to report any incident or hazard to Council in a timely manner. Under the terms of the Occupational Health and Safety Act 2004, I must follow all established practices, procedures and instructions of Council which apply to the tasks I have volunteered to perform.I understand that if I am successful, I will be required to complete a Police Check and provide Council with a Volunteer Working with Children Check. I understand that Additional requirements may be communicated in the acceptance letter, should my application be approved by Council.While I am assisting Council in the abovementioned clearly defined Council business activity, and while your assistance is approved/controlled and/or known by Council, I will be covered for Public Liability Insurance.I understand that I must adhere to all Council policies, procedures, legislation and reasonable direction applicable to volunteers.While acting as a volunteer, a limited personal accident insurance cover will be affected by Council subject to the terms and conditions of the policy.I understand that no payment will be made to me by Council for my volunteer activities.I understand that if I have a medical condition that may impact my work as a volunteer, I must disclose this to Council as soon as is possible.
Signature

By signing this form, I consent for my name to be published in the Council meeting Agenda and Minutes and published in Council’s website.
Signature

Clear
Date

MonthDayYear
Date
Next Steps
Your expression of interest will be submitted to Council for endorsement. If approved, we will notify you via letter and let you know of any additional requirements for your volunteer position. We will provide you with a timeframe that you will need to provide these requirements, along with your WWCC (if required) and Police Check information, to Council by. If you are not able to provide Council with the requirements listed in your approval letter within the proposed timeframe, your membership may be withdrawn. We will also notify the Committee (via the Secretary) of your membership and ensure that they communicate with you about any upcoming meetings.
Submission
Please submit this form to hr@hindmarsh.vic.gov.au, or return to any Customer Service Centre or Library. If you have any questions relating to this form, you can email the address above or call (03) 5391 4444.
Should be Empty:

Committee Membership Expression of Interest Form

Your Contact Details

Your Emergency Contact Details

Committee

Eligibility

Signature