Are you nominating a candidate, or are you nominating yourself?

If you are nominating SOMEONE ELSE, what is your relationship with, or connection to, the Candidate?

If you are nominating SOMEONE ELSE, is the Candidate aware that they are being nominated for this award?

NOMINATOR DETAILS (if you are NOT the Candidate):

Nominator (Your) Organisation:

Nominator (Your) Title/Position:

Nominator (Your) Mailing Address:

Nominator (Your) Work Phone Number:

Nominator (Your) Mobile Phone Number:

Nominator (Your) Email Address:

Nominator (Your) Fax Number:

CANDIDATE DETAILS:

Full Name Of PERSON BEING NOMINATED ("the Candidate"):

What is the Candidate's gender?

Candidate's Mailing Address

Candidate's Home Phone Number:

Candidate's Work Phone Number?

Candidate's Mobile Phone Number:

Candidate's Email Address:

Candidate's Date Of Birth?

Please attach Candidate's photo (head & shoulders) if available.

CANDIDATE'S TRAINING DETAILS:

Name of training Provider:

Name of course in full:

Completion date of training:

Completion date of training agreement (apprentices/trainees):

Apprentice or trainee registration number:

EMPLOYER DETAILS (where applicable):

Organisation name:

Organisation's Mailing address:

Contact person:

Position/Title:

Contact Person's Work Phone Number:

Contact Person's Mobile Phone Number:

Contact Person's Email Address:

NOMINEE'S SCHOOL DETAILS (where applicable):

School Name:

School Mailing Address:

Name Of VET Teacher:

VET Teacher Work Phone Number:

VET Teacher Fax Number:

VET Teacher Email Address:

RECOMMENDATION

Please make a comprehensive statement/recommendation here as to why this candidate should be considered for a Training Award. 

If there is insufficient space to complete the previous statement/recommendation, please attach a document containing same here:

If this form is being completed by the Nominator, as the Nominator, I confirm that the Candidate has read and Agrees with and Accepts the Club's Privacy Policy related to the Training Awards.  (Please note that this nomination will only be considered if the answer to this question is "Yes").

If this form is being completed by the Candidate, then, as the Candidate, I confirm that I have read and Agree with and Accept the Club's Privacy Policy related to the Training Awards.  (Please note that this nomination will only be considered if the answer to this question is "Agree and Accept").