Board Member Application Form

Your details

First Name *

Middle Name

Last Name *

Address *

Street address *

City *

State *

Postcode *

Email Address *

Phone Number *

Why would you like to join the Firstchance Board? *

Brief summary of your work experience: *

Please share any other board / organisational affiliations (including years of experience) *

Board meeting attendance can include a mix of in-person and online. Are you available to commit to attending some in-person meetings in Newcastle including a full planning day each November? *

YesNo

Any comments on in-person meeting attendance?

Your skills and experience

Other comments

Please upload your resume/CV or a cover letter *

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Board Competencies:

Please evaluate your personal capability to contribue to the Firstchance Board:

1 = most confident / 5 = least confident

Contextual Dimension: can adapt your perspective to the distinctive characteristic and culture of Firstchance *

Educational Dimension: can take steps to be well informed about Firstchance, the senior staff and the board's role, responsibilities and policies *

Interpersonal Dimension: ability to work collaboratively with others who may have different strengths/skills, foster a sense of cohesiveness and inclusion *

Analytical Dimension: recognise the complexities and subtleties in the issues facing not-for-profit boards and ability to work with ambiguity *

Political Dimension: understand the role of government and the inter-connection with not-for-profit organisations *

Strategic Dimension: ability to think and act strategically; understand Firstchance priorities and anticipate risks and act before issues become urgent *

Firstchance Board Nomination: Responsible Person Declaration

Under governance starndard 4, charites must be satisfied that their responsible persons (such as board or committee members, or trustees - what the Australian Charities and Not-for profits Commission Act 2012 (Cth) (ACNC Act) calls "responsible entities'') are not disqualified from managing a corporation or disqualified by the ACNC from being a responsible person.

Guidance and checklist

I am not disqualified from managing a corporation, within the meaning of the Corportations Act 2001 (Cth)

*

I have not been disqualified by the Australian Charities and Not-for -profits Commissioner at any time during the previous year from being a responsible person (what the ACNC Act calls a "responsible entity"of a registered charity *

While I am a responsible person for Firstchance Ltd, I agree to notify this charity as soon as possible if I do become disqualified from managing a corporation withing the meaning of the Corporations Act 2001 or am disqualified by the Australian Charities and Not-for -profits Commissioner. "Responsible persons" are the members of a charity's governing body, who share responsibility for the governance of the charity (called "responsible entities" under the ACNC Act).

I confirm I have read the guidance and completed the checklist above before signing the disqualifcation declaration *

Additional probity checks

Firstchance is a proud Child Safe Organisation and a Registered National Disability Insurance Scheme (NDIS) provider.

Firstchance is required to undertake a number of probity checks for all board members before a nomination to join the board can be accepted. These include:

Working with Children Check
National Police Check
NDIS Worker Safety Check
ASIC Banned & Disqualified Register check

Board members are also required to obtain a Director Identification Number (DIN).

I understand that if my application to join the board proceeds that I will be required to complete a range of probity checks. *

Signature *

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Date *