Application for appointment
Greater Blue Mountains World Heritage Area
Advisory Committee
Title:
Given name:
Family name:
Date of birth:
Residential address:
State:
Postcode:
Postal address (if different):
State:
Postcode:
Daytime telephone:
Mobile:
Email address:
Qualifications for Greater Blue Mountains World Heritage Area Advisory Committee membership:
Expertise and experience in community involvement in conservation
Expertise in Aboriginal cultural heritage
Scientific qualifications in the area of conservation (please select one):botanical/ecological
archaeological/cultural
zoological/ecological
water quality/aquatic
Expertise and experience in tourism or ecologically sustainable visitor use,
enjoyment and appreciation of reserves
Indigenous/traditional owner
Expertise in outdoor self-reliant nature based recreation
Expertise in non-Aboriginal cultural heritage conservation
Nominated by:
Self
Aboriginal organisation (please attach written endorsement from your local Traditional Elders)
Local government (please identify):
Other (please describe):
I have the following experience/expertise/qualifications: (If nominating for more than one area of expertise, provide
supporting evidence for each area. Attach a separate sheet if necessary.)
Occupation:
Professional/trade qualifications:
Are you a public servant?
If yes, which agency?
Please provide an up to date CV, detailing relevant skills, experience and academic training.
Maximum one page in length.
Page 2
Application for appointment
Greater Blue Mountains World Heritage Area
Advisory Committee
Have you previously served on a NSW National Parks and Wildlife Service Advisory Committee or World Heritage
Advisory Committee? (please provide details):
Membership of/affiliation with relevant organisation or other Government bodies:
(please list):
Details of any relevant activities or interests:
Equal Employment Opportunity statistics (please tick the applicable categories)
Female
Male
English is my first language
English is not mine or my parents’ first language
Ancestry (three generations if known):
Aboriginal or Torres Strait Islander descent
Age range:
18 – 25
26 – 40
Signed:
(electronic signature ok)
Person with a disability
41 – 64
65 and over
Date:
Applications close 5 pm 18 September 2015
Please email your completed form and attachments to Jacqueline.reid@environment.nsw.gov.au
Or print and post your completed forms and attachments to:
Jacqueline Reid
Senior World Heritage Officer
NSW National Parks and Wildlife Service
PO Box 6 Glenbrook NSW 2773
Or fax to:
(02) 4720 6250
Enquiries:
0419 307 099
Information submitted on this form, including any personal details will be a matter of public record and will be stored in the Office of Environment and Heritage
(OEH) records system. You can find out more about how OEH handles the personal information it collects online by reading our privacy policy. By submitting this
form, you consent to the collection and use of your personal information in accordance with this policy.
OEH 2015/0544