Candidate Application

APPLICATION - Local Council / Electorate Choice

I (your full name on electoral roll),* seek endorsement by Small Business Australia as a candidate for the Local Council or electorate listed below and acknowledge that I will read the candidate expectations document that will be emailed to me as a response to my submitting this form.

Which Local Council / electorate areas do you currently live in?*

Number of years you have lived in the Local Council / electorate area?*

I wish to nominate in the State/Territory of (Select State/Territory you wish to run in)* Select State / TerritoryAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia for:

Select Level of Government * Local CouncilState Lower HouseState Upper HouseFederal House of RepsSenate

Name of Local Council / Electorate / Upper House Region if applicable

APPLICATION DETAILS - Details will be kept confidential.

SBA Member No. (If not yet a member type TBA)*

Party Branch (if applicable)

Details including Electoral Roll address:

Date of Birth (dd/mm/yyyy)*

Place of Birth *

First Name *

Middle Name/s *

Last Name *

Marital Status* Select Statussinglemarrieddefactowidowed/erdivorcedseparatedother

Number of Children and ages*

Residential Address (as per Electoral Roll)

Unit/Street No. * Street Name *

Address 2

City/Town *

State / Territory * Select oneACTNSWNTQLDSATASVICWA

Postcode *

Postal Address (if different from above)

Unit/Street/PO Box No.

Street Name (if address is not a PO Box)

City/Town

State / Territory * Select oneACTNSWNTQLDSATASVICWA

Postcode

Preferred Contact Numbers and Email

Home Phone:

Work Phone:

Mobile Phone: *

Your Email *

Shadow Ministry and People's Cabinet

Small Business Australia is establishing a Shadow Ministry and People's Cabinet in line with current Government Ministries for Federal and each State and Territory Government.

We will have a quality team of Candidates across Australia that already includes a professional and experienced Shadow Ministry and People's Cabinet.

This way our policies and messages can be presented by people who already have experience in their respective Ministries, unlike many within the current parties in Government.

Are you interested in becoming a Portfolio Minister for Small Business Australia? *YesNo

If Yes, Please select Preferred Portfolio* Select Portfolio if YesAged CareAgricultureArtsAttorney-GeneralChildrenCities, Urban InfrastructureCommunicationsCommunity SafetyCustomsDefenceDefence IndustryDefence PersonnelDigital EconomyEducation and Workforce SkillsEmergency Services and ManagementEmissions ReductionEmploymentEnergyEnvironmentFamiliesFinanceFinancial ServicesFisheriesForeign AffairsForestryGovernment ServicesHealthHome AffairsHomelessness, Social and Community HousingHousingImmigration, CitizenshipIndigenous AustraliansIndustrial RelationsIndustry DevelopmentInfrastructureInternational Development and the PacificInvestmentLocal GovernmentMental Health and Suicide PreventionMigrant Services and Multicultural AffairsNational Disability Insurance SchemeNational Recovery and ResilienceNorthern AustraliaPublic ServiceRegional Development and TerritoriesRegional Education and Workforce killsRegional HealthRegional TourismRegionalisation, Regional CommunicationsResourcesRoad Safety and Freight TransportScience and TechnologySenior ustraliansSmall and Family BusinessSocial ServicesSportSuperannuationTourismTradeTransportTreasurerVeterans’ AffairsWaste ReductionWaterWomenWomen's Economic SecurityWomen's SafetyYouth

Questionnaire

1. List you prime areas of policy interest:*

2. What is your political philosophy?:*

3. List at least three key funding priorities you would champion in your electorate:*

4. What is your current occupation (please provide full details):*

5. Please list any educational qualifications:*

6. Please list your professional, trade or business experience:*

7. How will you balance campaigning with your work and other commitments?:*

8. Please provide details of any community involvement past and present:*

9. Have you ever been a member of or a candidate for any other political party? If so, which party/ies, in what capacity and when?:*

10. Have you been an independent candidate for any election in Australia including Local Government? If so please provide details:*

11. Please details any other political experience you may have:*

12. Have you ever been charged with an indictable offence or have you to your knowledge ever been under investigation in relation to an indictable offence. (Please provide details if applicable):*

13. Are you now or have you ever been bankrupt or have you now or ever entered into an arrangement with your creditors under the Bankruptcy Act? (Please provide details if applicable):*

14. Please outline your proposed strategies and budget on how you intend to run and fund your election campaign:*

15. Please provide contact details (phone/email) for three (3) referees (other than family members) who have known you for five years or more and are able to vouch as to your good character:*

16. Have you any other comments/information you would like to provide that may assist with your application to being preselected by Small Business Australia for your nominated seat?:*

I (your full name),* declare:

The answers I have given above in my application to be a candidate for Small Business Australia are true and correct in all respects;

• I am registered on the Electoral Rolls at the address provided.
• I will provide a recent headshot photo of myself.
• I understand that if my application is to proceed, I will be expected to undertake a formal interview, in person or via video link.
• I understand that if my application is successful, I will be required to Join Small Business Australia if I am not already a member.
• I understand that if my application is successful, I will be required to enter into a Candidate’s Agreement.

Declaration Acceptance: Enter Date (dd/mm/yyyy)*

Please Press 'send' once and wait for at least 30 seconds for confirmation of submission.