EOI Application Form

EOI

EOI ID

(*) indicates required field.

* College body seeking appointment (e.g., AFPHM Council, AYAM Committee, Cross College Exam Review Advisory Group)

* Position applying for (e.g., member)

Applicant details

Title

* First name

* Surname

Division, Faculty or Chapter you are a member of

Member Identification Number (MIN)

* What is your gender?

Male
Female
Prefer not to say
Self-described (please specify)

Contact details

* Email

* Phone

* Address

Selection criteria

* Expression of Interest Statement (500 words Maximum)

Please provide information to support your interest.

Attach CV

PDF and DOC file formats accepted.

Declaration of eligibility

By submitting this expression of interest (EOI) I hereby confirm that all information provided in support of my EOI is complete and accurate and is not misleading in any way.

Select choices

I am eligible to submit an EOI for this position

Select choices

I have not been removed from a College Body by the College Board in the previous five (5) years

Select choices

I understand and accept the College's Code of Conduct

Select choices

I declare that all material personal interests and actual/potential conflicts of interest that relate to the business and affairs of the College which would be required to be notified under the Corporations Act 2001 or the Australian Charities and Not for Profit Commission Act have been declared, should I be appointed as a College Body Member

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