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Gene Technology Technical Advisory Committee Nomination Form
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General Instructions

Gene Technology Technical Advisory Committee Nomination Form
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Before starting your form

This is the nomination form for the Gene Technology Technical Advisory Committee (GTTAC)

Additional pages may be attached where there is insufficient space on the form. Attachment fields are provided for each relevant question

Please DO NOT attach a separate Curriculum Vitae – all the information we require is contained in the form

The Minister must appoint one of the members to chair the committee. If you would like to be considered for the role of Chair, please ensure you complete Part 4 of this form.

CLOSING DATE FOR NOMINATIONS: 21 JUNE 2019

Saving your application

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Attachments

Individual attachments can be no larger than 5 MB. There is a total attachment size limit of 20 MB. If you reach or exceed the limit you will be unable to attach further files to this form. Please contact us on 1800 181 030 or email ogtr.applications@health.gov.au if your total attachment size is greater than 20 MB.

After you submit your form

When you submit your form you will receive an email receipt containing a PDF of your application. If we have not confirmed receipt within two weeks of submission or if you have any queries about the process please contact us on 1800 181 030 or ogtr@health.gov.au

Personal information

The information provided by you in this form is collected to assist the Department of Health (the Department) to support the Minister responsible for gene technology fulfil the requirements under Section 100 of the Gene Technology Act 2000, which relate to the appointment of members to the Gene Technology Technical Advisory Committee (GTTAC). Any personal information about you collected by the Department as a part of the appointment process will be managed in accordance with the Privacy Act 1988. In addition to the Minister, the Department may disclose any information you provide to the States; the Gene Technology Regulator; such scientific, consumer, health, environmental and industry groups as the Minister considers appropriate; and such other Ministers as the Minister considers appropriate, as part of the consultation required under Section 100(4) of the Act. Further information about the Department’s privacy policy can be found on its Privacy Policy page.

Further information

The OGTR can be contacted by telephone on 1800 181 030 or e-mail at ogtr@health.gov.au.

Further information is available on the OGTR website www.ogtr.gov.au.

Contact information

Gene Technology Technical Advisory Committee Nomination Form
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2. Personal Details

Date of Birth

Skills and Experience

Gene Technology Technical Advisory Committee Nomination Form
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3. Skills and Experience

The Act requires that, before making an appointment to GTTAC, the Minister must be satisfied that the person has skills or experience in one or more of the areas listed at Question 3.1.
The Minister must also appoint a layperson as a member of the Committee, and is not required to be satisfied that the layperson has skills and experience in any of the areas listed at Question 3.1. If you wish to be considered for this position please indicate by ticking the box below. If you have ticked this box, Questions 3.1 and 3.2 are optional.
3.1 Indicate those areas where you have skills and experience
3.2 Provide a brief justification for each area of skill or experience indicated above. Please think broadly about how your specific skills might fit into those listed.
Please note: This field has a character limit of 2000 characters (approximately 300 words). If you have additional details to provide, please use the attachment button below the field
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4. Committee Chair

4.1 Are you interested in being considered for the role of Chair of GTTAC?

Qualifications

Gene Technology Technical Advisory Committee Nomination Form
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5. Qualifications

Please provide details below of your qualifications and experience.

Please note: Each field has a character limit of 2000 characters (approximately 300 words). If you have additional details to provide, please use the attachment button below each field
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Publications, Committee experience, Leadership

Gene Technology Technical Advisory Committee Nomination Form
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6. Publications, Committee experience, Leadership

Please provide details below of your publications, committee experience and leadership.

Please note: Each field has a character limit of 2000 characters (approximately 300 words). If you have additional details to provide, please use the attachment button below each field
File:
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Conflicts of Interest

Gene Technology Technical Advisory Committee Nomination Form
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7. Conflicts of Interest

7.1 List any potential conflicts of interest The list should include potential interests, pecuniary or otherwise, you are aware of having in the kind of matters likely to be considered by GTTAC. Examples may include ownership of biotechnology shares, employment by a biotechnology company, etc. Please note that if your nomination is shortlisted you will be asked to complete a detailed Declaration of Interests, as required under subregulation 20(1) of the Gene Technology Regulations 2001, before appointments are finalised. If appointed to the committee, you will also be required to sign a Deed of Confidential Information and Conflict of Interest.
Do you have any potential conflicts of interest?
Office of the Gene Technology Regulator