Proudly supported by *Please attach a recent passport sized photo to your Application Form.

(OPTIONAL)

LIVERPOOL YOUTH COUNCIL APPLICATION FORM

PERSONAL DETAILS
NAME MALE / FEMALE (Please circle)

ADDRESS PHONE EMAIL

DATE OF BIRTH COUNTRY OF BIRTH LANGUAGE(S) SPOKEN AT HOME ABORIGINAL OR TORRES STRAIT ISLANDER AGE

MOBILE

Yes or No (Please circle)

Please indicate if you are: (Please tick more than one if applicable) At school [ ] Working [ ] At university or TAFE [ ] Looking for work [ ] Volunteer [ ] Other [ ] (Please state) Please indicate what school/ university/ job: ______________________________________ Please provide an example that you have worked on as part of a team. What was your role and what did you learn from this project. (For example, sporting teams, Clean Up Australia Day or a school project). Name of project: What was your role in the team project? What did you learn from this project?

LCC Ref: 014476.2012

Please tell us why you want to be a youth leader in your local community.

If you had a task to do (for example a household chore or a school assignment) how would you go about completing it on time? What strategies would you use?

Are there any other skills you can bring to the Liverpool Youth Council team? (e.g. Graphic design, report writing, public speaking, communication skills).

Have you participated in any community or extra- curricular activities? If yes, please specify.

How often could you attend regular meetings? Please think about your other commitments such as family, school, work and friends. (Please tick) [ ] monthly basis [ ] fortnightly basis [ ] weekly basis What days and times would you prefer to have the meetings on? (Please tick) (Please note this will only be used as a guide) [ ] Monday [ ] Thursday [ ] 4.30 6.30 [ ] Other time (Please state) [ ] Tuesday [ ] Friday [ ] 5.00 7.00 [ ] Wednesday [ ] 5.30 7.30 Would you prefer training to be on during a week night, or on a Saturday? (Please tick) [ ] Week nights [ ] Saturday Please provide a referee for us to contact. A referee is someone who knows you and can tell us what you
have done in relation to these questions.

Name: Relation: (For example, work colleague or teacher) Phone:

Return this form to: Derek Tweed, Liverpool City Council via Post: Ref: 2011/6252, Locked Bag 7064 Liverpool BC 1871 OR Fax: 9821 9333 OR Email: d.tweed@liverpool.nsw.gov.au

LCC Ref: 014476.2012