Function Enquiry Form

Date of Function

Type of Function

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Pre-Nomination Form for the Board of Directors

Your Details

Areas of Experience

Local community connection and involvement

Community Connection Example 1

Community Connection Example 2

Community Connection Example 3

Leadership experience in a corporate/business/not-for-profit context

Leadership Example 1

Leadership Example 2

Leadership Example 3

Experience as a director or member of a council/board/committee

Director Experience Example 1

Director Experience Example 2

Director Experience Example 3

Skills and Expertise

South Sydney Graphic Arts Club Mascot requires each Board Member to have a well-rounded mix of skills. Different members will contribute different expertise.

Please rate yourself from 1 (limited) to 5 (extensive) on the following areas:

1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5

Time Availability

South Sydney Graphic Arts Club Mascot Board Members are actively involved in club services and our community. Accordingly, directors are expected to have flexibility for scheduled participation in club and community events, and for monthly Board meetings. Please summarise your time availability below:

Personal Statement

Please outline what motivates you to serve on the Board of South Sydney Graphic Arts Club Mascot and how your experience and qualifications will equip you for this important role:

Referees

Please provide contact details of two relevant referees excluding family members.

Please ensure you meet the following requirements of The South Sydney Graphic Arts Club’s Constitution:

Rule 24.4 A member is ineligible to be nominated for or be elected or appointed to the Board if that member:

  1. is an employee of the Club;
  2. is currently suspended from the Club;
  3. is not a financial member of the Club;
  4. does not hold current Responsible Service of Alcohol and Responsible Conduct of Gambling qualifications;
  5. has not completed the Pre-Nomination Information Session referred to in Rule 24.5;
  6. has not been a member of the Club for at least three (3) continuous years immediately preceding the closing date of nominations or the proposed date for election or appointment to the Board;
  7. has received a notice of disciplinary charge and the disciplinary matter referred to in the notice of disciplinary charge has not been finalized;
  8. has been found guilty of any charge and either expelled or suspended from membership of the Club for a period exceeding three (3) months during the five (5) years immediately preceding the closing date of nominations or the proposed date of election of appointment to the Board;
  9. has at any time been convicted of an indictable offence;
  10. has, been convicted of any offence:
    1. connected with the promotion, formation or management of any company, cooperative, partnership or business;
    2. involving fraud or dishonesty and carrying a penalty of three (3) or more months imprisonment; or
    3. in relation to the acquisition of shares, during the five (5) years immediately preceding the closing date of nominations or the proposed date of election of appointment to the Board.
  11. is an undischarged bankrupt;
  12. was an employee of any club that has amalgamated with the Club, within the period of five (5) years immediately preceding the closing date of nominations or the proposed date of election of appointment to the Board;
  13. is an existing director of the Club who has failed to complete mandatory training requirements for directors referred to in Rule 26 within the prescribed period (unless exempted);
  14. has at any time been declared ineligible or not a fit and proper person to hold the position of director or has had an order made against them to the same effect;
  15. has, as a result of an assessment by a management liability underwriter when determining coverage under a directors and officers insurance policy or similar, has at any time, had imposed upon him or her:
    1. a loading on the usual premium; or
    2. a higher than usual excess.

And a reminder that Rule 24.5 states that: Members wishing to nominate for election to the Board must attend a “Pre-Nomination Information Session” conducted by the Club and any member who fails to attend the PreNomination Information Session shall not be eligible to nominate for or be elected to the Board.

Agreement

I believe that I am eligible for nomination for election to the Board of Directors and agree that I will not disclose to any unauthorised personnel, either during my voluntary engagement or after its termination, any confidential information that I may receive in the course of my membership of the Board of Directors of South Sydney Graphic Arts Club Ltd, Mascot.

The information provided by me is true and correct to the best of my knowledge.