Nomination Form
Tasmanian Council of Social Service Inc.
Nominations for election as a Board Member are invited and must be lodged, posted, or emailed to be received by the Returning Officer at the address shown below before the close of nominations at 10am Wednesday 27 October 2021. It is the responsibility of a candidate to ensure that their nomination reaches the Returning Officer before that time. Late nominations cannot be accepted. Eligibility requirements: • Candidates and nominators must be current members of TasCOSS or represent organisations that are current members. Associate members are not eligible. Prospective nominees in the Individual Membership category must be a personal financial member of TasCOSS – involvement with a TasCOSS member organisation is not acceptable. • Candidates and nominators who represent organisations must be currently recorded as the nominated representative of their Peak Body or Organisation (contact the TEC or TasCOSS if you are unsure of your status). • A valid nomination must be in writing and signed by the candidate and at least two (2) members nominating the candidate. Nominators from your own organisation are NOT permitted. Nomination for the position of (Please tick one)
Member holding Individual membership Representative from Regions – North/North West
Member who is a representative from a Peak Body Member who is a representative from an Organisation
Candidate details Surname
Given names
Residential address
Form of given name/s to appear on ballot paper
Peak Body/Organisation (if applicable) Region (if applicable)
Postal address (if different from above)
Contact phone numbers work:
Email address
mobile:
Candidate Declaration: I consent to the nomination for election as a Board Member of the Tasmanian Council of Social Service Inc. I declare that I am eligible under the Constitution to be elected. I agree to abide by the Council’s rules and commit to the objects of the Council.
Signature of candidate
Date
This notice of nomination must be signed by at least two (2) nominators who are members of the Council. Nominators from your own organisation are NOT permitted.
Name of nominator
Organisation
Signature of nominator
The address for lodgement at the Tasmanian Electoral Commission is: Level 3, 169 Main St. Moonah TAS 7009 email: nonstat@tec.tas.gov.au
Postal address: PO Box 307, Moonah TAS 7009. Phone: 1800 801 701 or 6208 8710
Candidate Statement overleaf…
Candidate Statement (150 words maximum) Pl e as e p rint
Your statement may be typed or neatly handwritten below or provided on a signed attachment. Your surname and ballot paper given name will appear at the beginning of your statement (not included in word count). Candidate statements: • are limited to a maximum of 150 words. • will be shortened by the Returning Officer if they exceed 150 words. • are not compulsory for a valid nomination. • may not mention another candidate unless the written consent of that candidate is received by the Returning Officer with the nomination form. • must be received by the Returning Officer with the nomination form.
I, (please print name) Personal Information Protection Statement (required under the Personal Information Protection Act 2004). take responsibility for the accuracy of the information contained in my candidate statement (above or attached).
(signature)……………………………………………………………
1. Personal information will be collected from you for your nomination for the TasCOSS election and will be used by the Tasmanian Electoral Commission for assessing and managing the nomination and may be used for other purposes permitted by the Council’s Constitution. 2. Failure to provide this information may result in your nomination not being able to be accepted and processed. 3. Your personal information will be used for the primary purpose for which it is collected and may be disclosed to contractors and agents of the Tasmanian Electoral Commission. 4. Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the Tasmanian Electoral Commission. You may be charged a fee for this service.