Local Government ProcurementBoard Application

Applicant details

Salutation / ☐ Mr ☐ Mrs ☐ Ms ☐ Miss ☐ Dr ☐ Other:
First Name / Middle Name
Surname / Date of Birth
Home / Work / Mobile
Residential Address
Postal Address

Applicant’s Skills, Experience and Memberships

Successful boards have members with a variety of skills and experience. The information below will be used to help assess your application.

1. What is your occupation?
2. Please detail the skills and attributes you have to offer the Board.
Essential Criteria
Industry Experience/ Knowledge. Youmust DEMONSTRATE skills/experience in at least 2 of the following 3 areas:
Working knowledge/commercial experience in strategic procurement and supply chain management
Experience as a CEO/Senior Executive/Director
Working knowledge and/or understanding of the local government sector
Other Key Competencies. You must have DEMONSTRATEDknowledge/experience in at least two or more of the following 5 areas:
(i)Business Strategy
Understanding of what constitutes effective business strategy and how to achieve best value for money in the procurement of goods and services
Experience in the identification of business opportunities and strategic planning
(ii)Governance
Understanding of the role of the Board (as outlined in the Constitution)
Awareness of the key provisions and obligations under the Corporations Act
Knowledge of best practice corporate governance structures, policies and processes and an ability to apply where relevant
Ability to identify key issues and contribute to the development and implementation of LGP policies
Experience/knowledge of executive performance management relevant to management of the CEO
(iii)Financial Management, Audit and Accounting
Knowledge or skills in accounting and knowledge of financial control concepts and statutory reporting requirements
Experience in analysing and interpreting financial statements
Appreciation of internal audit roles and responsibilities
Experience in budget planning and monitoring
(iv)Risk Management & Compliance
Experience in developing and implementing risk management systems
(v)Formal training in Governance or as a Director
Completed formal training in governance or as a Director (eg AICD or equivalent course)
3. Please list any professional or other qualifications, attach certified copies to evidence each qualificationand complete the ‘supporting document checklist’.
Qualification / Date Completed
4. Are you a member of any other Government or non-Government boards or committees? / ☐ Yes. If yes, please provide details below
☐ No
5. Are you a member of any relevant special interest groups? / ☐ Yes. If yes, please provide details below
☐ No

Referees

Please provide the names and contact details of two (2) referees in support of your application:

First Name / Surname
Address
Contact Number
Email
First Name / Surname
Address
Contact Number
Email

Declaration

1. Have you ever been declared bankrupt or sought protection from any bankruptcy laws? / ☐ Yes. If yes, please confirm details
☐ No
2. Have you ever been convicted anywhere is Australia or overseas of an offence that, if committed in NSW, would be punishable in NSW by at least 12 months imprisonment? / ☐ Yes. If yes, please confirm details
☐ No
3. If you are appointed to the board, are there any circumstances that you are aware of that may give rise to an actual, perceived or potential conflict of interest? / ☐ Yes. If yes, please confirm details
☐ No
4. If selected for appointment, I agree to undertake the Induction Program. / ☐ Yes. If yes, please confirm details
☐ No
I declarethe answers and information given in this application are true and correct and I have not withheld any information likely to affect the success of my application.
I consent to the collection, storage, use and disclosure of my personal and sensitive information in accordance with the Privacy Act 1988, for both the primary purpose of assessing my application for Board membership, and if appointed, for the secondary purpose of disseminating to me information, notices and details regarding the Board; and
I authorise LGNSW to reference relevant sources to confirm the information that I have supplied in this application and any accompanying attachments to determine my eligibility and suitability for appointment to the Board.
Please print your full name
Signature / Date

Lodgement

By email to:

By mail to: Magdalena Przybylo, Executive Assistant, Local Government NSW, Level 8 28 Margaret Street SYDNEY 2000

Supporting documentation checklist

☐ I have included a copy of my resume to support my application

☐ I have included certified copies of all educational and professional qualifications listed in my application

Page 1 of 4

Local Government Procurement: Board application