Current Employer Position Period of Service Employment Previous Employer Position Period of Service Employment (please list) Current membership of any other bodies (i.e. board membership, committees, council membership, community groups). Body Position Period of No of times Service appointed: Section 3 Names, email and contact Name: telephone numbers of 2 referees * Email: Name: Email: *Please Referees may be contacted upon receipt of candidate applications to complete a short referee note: questionnaire.
Current Employment Employer Position Period of Service Previous Employment (please list) Employer Position Period of Service Current membership of any other bodies (i.e. board membership, committees, council membership, community groups). Body Position Period of Service No of times appointed: Section 3 Names, email and contact telephone numbers of 2 referees * Name: Email: Name: Email: *Please note: Referees may be contacted upon receipt of candidate applications to complete a short referee questionnaire.
2018-Gippsland-PHN-Board-Director-Election-Process-Director-Candidate-Details-Form.docx