Reserves: Crown Reserve Trust Board Membership Application - Land

• consent to the collection, storage, use and disclosure of my personal and sensitive information inaccordance with the Privacy Act 1988, for both the primary purpose of assessing my Applicationfor Reserve Trust Board membership, and if appointed, for the secondary purpose ofdisseminating to me information, notices and details regarding the Trust Board; and• authorise NSW Trade & Investment, Crown Lands to reference relevant sources to confirm theinformation that have supplied in this Application and any accompanying attachments todetermine my eligibility and suitability for appointment to a Reserve Trust Board.I understand that: my personal information may be disclosed to other NSW Government departmentsand agencies, including the Department of Premier and Cabinet, and/or Ministers for the purposes of theappointment process.Please print your full nameSignatureLodgementDate / /• Mail to NSW Trade and Investment Crown Lands, PO Box 2185 DANGAR NSW 2309• or email to reserves@lands.nsw.gov.au• or fax to (02) 4925 3517Supporting documentation checklistI have included a copy of my resume to support my applicationOffice Use only – Refer to the Receipting and Referrals Codes DocumentBCD Code Account NumberTrust Board CategoryEntered by (staff members name)Staff initialDate / /© State of New South Wales through the Department of Trade and Investment, Regional Infrastructure and Services 2013. This publication is copyright.You may download, display, print and reproduce this material in an unaltered form only (retaining this notice) for your personal use or for noncommercialuse within your organisation. To copy, adapt, publish, distribute or commercialise any of this publication you will need to seek permissionfrom the NSW Department of Trade and Infrastructure, Regional Infrastructure and Services.Page 7 of 7Reserves: Crown Reserve Trust Board Membership ApplicationTRIM DOC14/003149 {FOR017} {Version 0.1}, {Jan 2014}