ACEM Networks: Application to fill casual vacancies

Expression of Interest Form: Community Member

Please complete this form to submit an Expression of Interest for appointment as a Community Member on the Australasian College for Emergency Medicine (ACEM) Global Emergency Care Committee (GECCo) for the 2025-2027 term of office.

To be eligible, individuals must not be a College member, must not be enrolled in an ACEM training program, and must not be otherwise ineligible under College regulations or the ACEM Constitution. ACEM Community Members currently serving on a College entity are eligible to apply.

Applications close at 9:00am AEST on Friday 24 October 2025.

1. Applicant Details

Please provide your details below.

ACEM ID (if applicable)

Name:*

TtileFirst NameLast Name

Email:*

example@example.com

Address:*

Street Address

Street Address Line 2

CityState / Territory

Postal / Zip Code

Phone number:*

Please indicate your gender identity:*

Are you Aboriginal, Torres Strait Islander or Māori? (please select all boxes that apply):*

Yes, AboriginalYes, Torres Strait IslanderYes, MāoriNone of the above

2. Available Positions

The composition of the Global Emergency Care Committee (GECCo) includes a community member, appointed by the Global Emergency Care Committee and ACEM Recruitment pursuant to the Policy on the Appointment and Remuneration of Community Members (COR498). Applicants with experience in the international development sector, healthcare systems within Low- and Middle-Income Countries (LMICs), or international volunteer work are encouraged to apply. This individual may come from a range of professional backgrounds, including research, academia, allied health, nursing, or program management.

Please provide an outline below of your lived experience and/or acknowledged expertise relevant to the matters being considered by the Global Emergency Care Committee.*

3. Supporting Statements

a) Statement of Intent

Please provide a brief statement that describes the contribution that you feel you could make to the ACEM Global Emergency Care Committee and addresses the requirements of the role and relevant experience (not exceeding 500 words):*

0/500

b) Statement on the ACEM Core Values

The ACEM Core Values of respect, integrity, collaboration, and equity define the organisation’s guiding principles, and underpin the way ACEM works in order to meet its vision and mission of ensuring the highest standards are maintained in the training of emergency physicians, and in the provision of emergency care to the communities of Australia and Aotearoa New Zealand.

Please describe how you demonstrate a commitment to the ACEM Core Values (not exceeding 500 words):*

0/500

4. ACEM Core Values Module

All appointees to ACEM roles and entities are required to have completed the ACEM Core Values module. Please indicate if you have completed the module or confirm your undertaking to complete the module if appointed.

ACEM Core Values module status:*

Yes, I have completed the ACEM Core Values moduleNo, I have not completed the ACEM Core Values module but I undertake to complete if appointed as a Community Member

5. Curriculum Vitae

The Curriculum Vitae provided will be made available to members of the Committee, ACEM Recruitment and/or their delegates for consideration of appointment. Please ensure any personal details are omitted, as required.

Please upload a copy of your current Curriculum Vitae:*

Browse Files

6. Conflicts of Interest

ACEM requires all entity members to disclose any conflicts of interest (perceived or actual) in line with the Conflict of Interest Policy (COR139). Please indicate any conflicts of interest to be considered in the context of potential appointment to the ACEM Indigenous Health Committee. If there are none, then please leave this field blank.

Conflicts of Interest:

7. Declaration

I declare that the information provided in this application is true and accurate to the best of my knowledge. I confirm that I provide the perspective of non-clinical individuals on emergency medicine care to the Global Emergency Care being that I am not a College member, not enrolled in an ACEM training program, and not otherwise ineligible for appointment pursuant to College regulations or policies. I also acknowledge that my Curriculum Vitae and Supporting Statements will be made available to members of the committee, ACEM Recruitment and/or their delegate for consideration of appointment.

Signature (please make your mark on screen)*