Nomination form: Carer representative

1. Family name *
2. First name(s) *
3. Date of birth *
4. Gender *
5. Email *
6. Phone *
7. Residential address *
8. State *
9. Postcode *
10. Do any of the following descriptions apply to you? *

    • Young Carer (aged under 25 years)
    • Older Carer (aged over 65 years)
    • Aboriginal person
    • Torres Strait Islander person
    • Australian South Pacific Islander person
    • Culturally/linguistically diverse background
    • LGBTQIA+
    • Person with disability
    • Living in regional, rural or remote area
    • None of these

Referees should have a thorough knowledge of your role as a carer organisation representative, your involvement in the community and/or be able to provide a character reference.

1. Please attach a copy of your current resume or curriculum vitae *
2. Describe your lived experience as a carer *
3. Describe your involvement in community activities and connection to community networks *
4. What are the most important issues or concerns for you as a carer or among carers you know? *
5. What other information do you think is relevant to this role? *
6. Membership to, or participation in, other government bodies (e.g. committees, boards etc.) *

1. Full name *
2. Please read the following statements carefully and check each box. *

   • I have read and agree to the functions required as a member of the Queensland Advisory Council, as defined in section 12 of the Carers (Recognition) Act 2008.
   • I have read and understand the contents of this form and confirm I am eligible to submit an application for nomination to the Queensland Carers Advisory Council.
   • I certify that the information provided in this form and contained in the attached documents is true and correct.
   • I understand that any responses within, or information provided, as a result of this application will be used by the Department of Families, Seniors, Disability Services and Child Safety to assess my suitability.
   • I understand that I am giving consent for the Department of Families, Seniors, Disability Services and Child Safety to provide information to State Library Queensland to undertake a GRAIL check if I am shortlisted for appointment.