• Expression of Interest

    CSSANZ Foundation Board Member

    The CSSANZ Foundation is seeking expressions of interest from CSSANZ members to join the Foundation Board and support the governance and oversight of the Foundation.

    The CSSANZ Foundation promotes, supports and develops research programs within the specialty of colorectal surgery in Australia and New Zealand to enhance the quality of life of patients and their families. It is an incorporated not-for-profit company registered with the Australian Charities and Not-for-profits Commission (ACNC), with its unitary shareholder being the membership of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ).

    Eligibility Requirements

    We welcome expressions of interest from current Full Ordinary Members or Fellows of CSSANZ with a strong commitment to active Board participation and an interest in supporting colorectal surgical research. 

    Please include:

    • Your key strengths and suitability
    • Clinical background and area of specialisation
    • Previous board or committee experience
    • Your interest in and views on colorectal surgical research
    • Current CV

    Important Information

    Closing date: 5:00pm AEST, Friday 7 August 2026

    We strongly recommend signing in with a Jotform account using Google, Microsoft, Facebook, Apple, or an email-based login. This allows you to save your progress and return to your application later.

    If you do not sign in, the form must be completed in one sitting. Any progress will be lost if the form is closed.

    Please complete the expression of interest form below to apply for a position on the CSSANZ Foundation Board.

  • Format: (000) 000-0000.

  • Applicant Declaration and Consent

    Before proceeding with this application, applicants must acknowledge the following:
  • I acknowledge and consent to the CSSANZ Foundation undertaking verification and probity checks relevant to this application, including searches of professional registration, director eligibility, insolvency, and charity governance records in Australia and New Zealand.*
  • I understand that progression of my application may be subject to the outcome of these checks.*

  • Colorectal Surgical Society of Australia and New Zealand Foundation | ABN: 55 108 556 207

  • Expression of Interest: Professional Background and Supporting Information

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Colorectal Surgical Society of Australia and New Zealand Foundation | ABN: 55 108 556 207

  • Clinical Privileges

  • Have your Clinical Privileges and/or appointment at any hospital or day procedure centre ever been denied, reduced, suspended or revoked or have you had conditions attached to that appointment for any reason?*
  • Have you ever been subject to an adverse finding or had conditions attached to your medical indemnity insurance policy or registration by a Medical Board?*
  • Have there ever been any serious adverse findings made against you which would be relevant to your appointment (for example: breach of insurance/medical laws, professional misconduct, sexual assaults or assault) by the Health Insurance Commission, a Medical Board, a Health Care Complaints Commission/Body, a Coroner, a Court or any other professional, disciplinary or similar body?*
  • Have you ever had limitations or conditions applied by your insurer/indemnifier on your existing Indemnity policy?*
  • Have you ever had your membership of the Royal Australasian College of Surgeons (RACS) suspended, restricted, or terminated?*

  • Director Eligibility and Consent

  • Are you currently disqualified, banned, or otherwise prohibited from acting as a company director or managing corporations in Australia, New Zealand, or any other jurisdiction?*
  • Have you ever been declared bankrupt, entered into a personal insolvency arrangement, or been subject to a court or regulatory order relating to the management of corporations or charitable organisations?*

  • Colorectal Surgical Society of Australia and New Zealand Foundation | ABN: 55 108 556 207

  • Applicant Declaration and Consent

    I, {name}, am expressing my interest in joining the CSSANZ Foundation Board.

    I acknowledge and consent to the CSSANZ Foundation undertaking verification and probity checks relevant to this application, including searches of professional registration, director eligibility, insolvency, and charity governance records in Australia and New Zealand.

    {iAcknowledge}

    I understand that progression of my application may be subject to the outcome of these checks.

    {iUnderstand}

  • Unable to Proceed

    Dear {name},

    Thank you for your interest in joining the CSSANZ Foundation Board.

    As acknowledgement of the declaration and consent requirements is mandatory for all applicants, you are unable to proceed with this application at this time.

    If you believe this is in error, please contact the CSSANZ Office.

    CSSANZ Foundation
    e: cssanz@cssanz.org

  • Date*
     - -

  • Colorectal Surgical Society of Australia and New Zealand Foundation | ABN: 55 108 556 207

  • Should be Empty: