ApplicationforAppointmenttotheBoardofDirectorsof The
Society of Hospital Pharmacists of Australia
1. PersonalDetails
Title:
Givennames:
Familyname:
2. ContactDetails
Pleaseonlyprovidedetailsatwhichyouarehappytobecontactedinrelationtothisposition.
Homephone: / Work phone:
Mobilephone:
E-mailaddress:
Postaladdress:
3. CurrentEmploymentDetails(ifapplicable)
Occupation:
Employer:
Address:
4. TertiaryandOtherRelevantAcademicorProfessionalQualifications
Qualification / University/Institute / Dateawarded
5. CommitteeorBoardExperience
PleaselistanyexperienceonBoards,BoardcommitteesorAdvisoryCommittees.
Position/Title / Organisation / StartDateEndDate
6. Memberships
Pleaselistmembershipsofanyprofessionalorindustrybodies.
Membershiplevel / Body / StartDate
7. ConflictsofInterest
DoyouhaveanyinterestsinacontractorproposedcontractwithSHPA? / ☐ Yes / ☐ No
Ifyes,pleaseprovidedetails:
Doyouholdanofficeorhaveaninterest,wherebywhetherdirectlyor indirectly,aconflictcouldarisewithyourdutiesandinterestasaDirectorof SHPA? / ☐ Yes / ☐ No
Ifyes,pleaseprovidedetails:
8. TimeCommitment
Doyouhavesufficienttimeavailabletomeetthecommitmentrequiredof Directors?Overthecourseofthenext12 months,eachDirectorisexpected to:
  • Prepare,travelandattendaminimumof4 face-to-facemeetingsperyear.
  • Prepare and attend a minimum of 6 teleconference meetings per year
  • AttendanceataStrategicPlanningWorkshop(one-day).
  • Attendance at the Annual General Meeting
  • Attendtoallothermattersincludinganysuchattendancesasarenecessaryto fulfiltheroleofDirector
/ ☐ Yes / ☐ No
9. Where did you hear about the Call for Nominations?
Please provide details:
10. Director Pre-Appointment Checks
The following background checks may be undertaken in respect of a potential director who is selected for interview. Do you give permission for the following pre-appointment checks to be undertaken:
  • Referees
Potential directors nominate referees who can comment on their suitability for service as a director
  • Bankruptcy
A person who has been, or who becomes, bankrupt will typically be disqualified from appointment, or continued membership of a board. The following two checks are undertaken:
-Australian Security and Investment Commission Register of Persons Prohibited or Disqualified by ASIC under provision of the Corporations Act 2001 (Cwlth)
-Insolvency and Trustee Service Australia National Personal Insolvency Index
  • Police Check
A person convicted of an offence, unless it is very minor, may not be suitable for service on a board.
  • A declaration of private of interest provided by the potential director
This discloses actual or potential conflicts of interest.
  • Disqualification from acting as a director
A person who has ever been disqualified by a court or the Australian Securities and Investments Commission from acting as a director or manager may not be suitable as a director. / ☐ Yes / ☐ No
11. References
Providethenamesandcontactdetailsof twopeoplewhoarepreparedtoprovideareference aboutyou.
Pleaseonlyprovidecontactdetailsatwhichyourrefereesarehappytobecontacted.
Referee1
Name:
Relationship to Applicant:
Homephone: / Work phone:
Mobilephone:
E-mailaddress:
Referee2
Name:
Relationship to Applicant:
Homephone: / Work phone:
Mobilephone:
E-mailaddress:
Why are you interested in being on the SHPA Board?
Pleaseprovidedetails (up to 250 words):
SkillsSelf-Assessment
Pleasenote:ItisnotexpectedthateachindividualDirectorwill holdall relevantprofessionalandindustryskills.However,itis expectedthese skillswillcollectivelybeheldbytheBoard.
Pleaseproviderelevantdetailsagainstyour 3 keyskillsfrom the list below (please note word limit of 250 words per skill).
Any further relevant information may be provided in the ‘Other’ section listed below.
Skills List:
Strategy: Abilitytothinkstrategically,identifyandcriticallyassessstrategicopportunitiesandthreats,andto developeffectivestrategiesinthecontextoftheobjectivesof the SHPAand relevantnationalpoliciesandpriorities.
Financial Performance: Suitableexperienceinaccountingand/orfinanceandtheabilitytoanalysekeyfinancialstatements, criticallyassessfinancialviabilityandperformance,contributetostrategicfinancialplanning,oversee budgetsandefficientuseof resourcesandoverseefundingarrangementsandaccountability.
Corporate Governance:Knowledgeandexperiencein best practice corporate governance including the fiduciary and legislative frameworks that underpin the organisation in the not-for-profit context.
Information Technology and Digital Disruption: Knowledgeandexperienceinthestrategicuseandgovernanceofinformationmanagementand informationtechnology including transformation caused by emerging digital technologies.
Communications: Knowledge and experience in strategic and corporate communications, with an ability to apply this in a non-profit or healthcare context.
Commercial/Executive Management:Abroadrangeofcommercial/businessexperience,preferablyinthesmalltomediumenterprise context.Exampleskillsmayincludeset-up of businesses, business systems, practices and improvement.
Health Care:Experience in health care, for example, general practice, nursing, allied health, pharmacy or aged care.
Understanding of the Pharmacy sector:Knowledge and experience in respect of the delivery of pharmacy services, in hospital or community settings, including contemporary issues and the policy environment.
Legal:Knowledge, experience and understanding of legal issues relevant to a not for profit organisation.
Advocacy: Experience and understanding of representing an organisation to key stakeholders and sectors such as government, funding agencies and the health workforce sector.
Strategic Partnerships:Experience and networks with pharmacy stakeholders including pharmacy organisations, government, primary and tertiary health care providers and the ability to effectively engage and communicate with those stakeholders.
Risk and Compliance Oversight:Ability to identify key risks to the organisation in a wide range of areas including legal and regulatory compliance, and monitor risk and compliance management frameworks and systems.
Not for Profit Organisation:Knowledge and experience of the organisational management of a not for profit/government funded organisation.
Skillset #1:
Pleaseprovidedetails up to 250 words:
Skillset #2
Pleaseprovidedetails up to 250 words:
Skillset #3
Pleaseprovidedetails up to 250 words:
Other (if required)
Pleaseprovidedetails up to 250 words:

Please submit your completed APPLICATION and CVto:

SUBMIT TO:

CLOSING DATE:COB Monday29 January 2018

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