Board Member Application – Dundaloo Support Services

Full Name

Date of Birth

Gender

Address

City / Suburb

Postal Code

Phone

Highest Level of Education Attained

Institution

Current Occupation

Employer

Years of Experience

Qualifications

Professional Memberships

Why are you interested in serving on the Board for Dundaloo Foundation Ltd?

Anything further about your skills and experience

Have you previously served on a Board?

Yes No

Please provide details of your Board experience

Do you have any actual, potential, or perceived conflicts of interest that may affect your role as a Director?

No Yes

Please provide details of the conflict

I am over 18 years of age

Yes No

I am legally eligible to serve as a Company Director

Yes No

I am willing to undertake the following background checks

National Police Check NDIS Worker Screening Check (if required) Director Identification Number (Director ID)

Current Resume

Any additional information you would like the Board to consider

How we handle your information. Dundaloo Foundation Ltd collects the information in this form to assess your suitability for a position on our Board. It includes sensitive information, such as your date of birth and any lived experience of disability you choose to share. Your application is sent to the Board and is accessible only to Board members and the selection panel. We keep unsuccessful applications for 12 months and then destroy them. We will not use your information for any other purpose, or disclose it to anyone else, without your consent, except where required by law. If you consent to background checks, we will contact you before any check is started. You may request access to or correction of your information at any time. See our Privacy Policy or contact us for details.

I have read and understood how my information will be handled.

I hereby confirm that the information provided is accurate and complete.

Full Name (typed, in place of a signature)