MEENIYAN COMMUNITY HUB: COMMUNITY ASSET COMMITTEE

MEENIYAN COMMUNITY HUB - COMMUNITY ASSET COMMITTEE

Please fill out this form to nominate yourself as part of our new Committee.
Nominations are being called to fill Committee of Management positions on Council’s Meeniyan Community Hub Asset Committee.

Appointment to the Committee is subject to Council approval.

Council is keen to ensure that the Committee is representative of a balance of interests and views from the community the Committee serves.

Nominations must be lodged with the Chief Executive Officer by mail, Private Bag 4, Leongatha 3953 or email, council@southgippsland.vic.gov.au.

Nominations close Wednesday 26 Novermber 2025.
PERSONAL DETAILS
NAME*
ADDRESS*
CONTACT NUMBER*
EMAIL*
PERSONAL BACKGROUND

To assist Council in making the best match between your skills, experience and interests and the role of a Special Committee member please complete the following section about yourself.
WHAT IS IT THAT INTERESTS YOU IN THIS ROLE? *
WHAT QUALIFICATIONS OR SKILLS DO YOU OFFER?*
WILL YOU BE REPRESENTING A COMMUNITY GROUP ON THIS COMMITTEE?*

YesNo
WHICH GROUP WILL YOU BE REPRESENTING?
Do you have any medical conditions, allergies or use any medication which may affect your work as a Special Committee member? Please provide details. Please note that failure to fully disclose any pre-existing medical condition, to the limit of your knowledge, may affect the extent of cover provided by Council’s Insurance Policy. *
Inductions will take place Monday 1 December between 2.00pm to 4.00pm in Meeniyan. Can you attend?*

YesNo
PRIVACY COLLECTION NOTICE

I acknowledge South Gippsland Shire Council’s primary purpose of collecting personal information within this Nomination for Committee form will be used for the recruitment related to the Committee. Failure to provide correct details may result in this nomination being rejected.

All personal information provided in this form will be managed in accordance with the Privacy and Data Protection Act 2014 and the Health Records Act 2001.
NOMINEE SCREENING PROCESS

A National Policy Records Check and / or Working with Children Check are required for some volunteer and paid staff positions within Council. These checks will be funded by, and remain the property of Council. You will be notified if a committee membership role requires any particular screening process. It is not possible to continue in the role until the screening process is finalised.

For more information in relation to this nomination form please contact Council’s Community Development Team on 5662 9200.
DATE*
NAME*
SIGNATURE*

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MEENIYAN COMMUNITY HUB - COMMUNITY ASSET COMMITTEE