Application Form for FSC Pesticides Policy Working Group Please submit together with your CV to: pesticides.policy@fsc.org by 31 January 2016 Please select the subgroup you would like to become part of: ☐ Stakeholder subgroup ☐ Technical expert subgroup Please select the interest you represent: (see classification criteria in Annex 1) ☐ Economic ☐ Environmental ☐ Social Please select the socio-economic region you represent: (see list of countries classified as North or South in Annex 2) ☐ North ☐ South Background Information Name: Position: Organization: Phone: E-mail: 1. Please describe your interest in participating on this working group: Knowledge/Experience 2. Please describe how you meet the qualifications specified in the Terms of Reference for this Working Group, including all qualifications in which you have expertise and knowledge. If you are applying to be a member of the technical expert subgroup, please describe also your scientific career: 3. Please describe whether and how you were involved in the development of the FSC Pesticides Policy or any related document: 4. Have you previously been involved in interest-balanced and consensus-based processes? If so, please describe your experience: 5. If required, FSC agrees to negotiate a fee for the participation in the WG discussions. However, active and effective participation on this working group will take a significant investment of time during certain periods in the process. Do you have any concerns about making this time commitment and if so, please describe: 6. Is there anything else you would like to share regarding your candidacy on this working group? Thank you! Annex 1. Working group member’s criteria to the three interests: 1) Economic Applicants representing individuals, companies and organizations that principally have a commercial interest in forest management, the production, processing or commercialisation of forest products, or in the activities of the Organization, including, but not limited to the following. a) b) c) d) e) Forest management and forest product companies. Manufacturing companies. Wholesalers, retailers, traders and brokers. Consulting firms. Commercially oriented communally - owned forest enterprises, indigenous organizations or community groups. f) Industry associations. g) Research organizations and academics whose primary interests are the economic or trade of forest products. h) Certification bodies. i) Government owned or controlled entities j) Employees, consultants and representatives of the above. 2) Social Applicants representing individuals and not-for-profit organizations whose principal purpose and interest is socially beneficial forestry, including, but not limited to the following. a) Socially oriented communally- owned organizations, indigenous organizations and community groups. b) Trade unions, labour unions and workers associations. c) Non - Governmental Organizations engaged in social development, social justice, strengthening civil society or similar. d) Organizations and associations working to promote recreational uses of forests. e) Research organizations and academics whose primary interests are social issues within forestry. f) Development non - governmental organizations. g) Employees, consultants and representatives of the above. 3) Environmental Applicants representing individuals and not-for-profit organizations whose principal purpose and interest is the protection, preservation or conservation of the natural environment, including, but not limited to the following. a) Environmental non - governmental organizations. b) Environmental interest groups. c) Research organizations and academics whose primary interest is the protection, the technical aspects of forest management and the preservation or conservation of the natural environment. d) Environmentally oriented communally - owned organizations, indigenous organizations and community groups. e) Employees, consultants and representatives of the above. Annex 2. List of countries classified as North or South (Draft June 2015) North South AUSTRALIA AUSTRIA BAHAMAS BAHRAIN BELGIUM BRUNEI DARUSSALAM CANADA CAYMAN ISLANDS CROATIA (Hrvatska) CYPRUS CZECH REPUBLIC DENMARK ESTONIA FINLAND FRANCE GERMANY GREECE GUAM HONG KONG IRELAND ISRAEL ITALY JAPAN LIECHTENSTEIN LITHUANIA LUXEMBOURG MALTA NETHERLANDS NEW ZEALAND NORWAY OMAN POLAND PORTUGAL PUERTO RICO QATAR SAN MARINO SAUDI ARABIA SINGAPORE SLOVAKIA SLOVENIA SPAIN SWEDEN SWITZERLAND UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES ALBANIA ARGENTINA BANGLADESH BELARUS BELIZE BOLIVIA BOSNIA AND HERZEGOVINA BRAZIL BRITISH VIRGIN ISLANDS BULGARIA CAMBODIA CAMEROON CHILE CHINA COLOMBIA CONGO, THE REPUBLIC OF COSTA RICA COTE D'IVOIRE DOMINICAN REPUBLIC ECUADOR EGYPT ETHIOPIA FIJI GABON GHANA GIBRALTAR GUATEMALA GUYANA HONDURAS HUNGARY INDIA INDONESIA KAZAKHSTAN KENYA KOREA, REPUBLIC OF LAOS LATVIA LEBANON MACEDONIA MALAYSIA MEXICO MONACO MONTENEGRO MOROCCO MOZAMBIQUE NAMIBIA NEPAL NICARAGUA PAKISTAN PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES ROMANIA RUSSIA SAMOA SENEGAL SERBIA SEYCHELLES SOLOMON ISLANDS SOUTH AFRICA SRI LANKA SURINAME SWAZILAND TAIWAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TUNISIA TURKEY UGANDA UKRAINE URUGUAY VENEZUELA VIETNAM ZAMBIA ZIMBABWE