Candidate Application

APPLICATION - Electorate Choice

I (your full name on electoral roll),*
being a member of Federation Party Australian Capital Territory, seek endorsement by the Party as a candidate for the 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. I can also download the document here You can download Candidate Expectations Document here if you wish to.

Which electorate do you reside in?*
Choose ElectorateBrindabellaGinninderraKurrajongMurrumbidgeeYerrabi

Number of years you have resided in the electorate?*

I wish to nominate in the following Electorate*
Choose ElectorateBrindabellaGinninderraKurrajongMurrumbidgeeYerrabi

APPLICATION DETAILS - Details will be kept confidential.

AFP Member No. If Not a Member Yet, type TBC *

Party Branch (if applicable)

Details including Electoral Roll address:

Date of Birth (dd/mm/yyyy)*

Place of Birth *

First Name *

Middle Name/s (type nil if none) *

Last Name *

Marital Status*
Select Statussinglemarrieddefactowidowed/erdivorcedseparatedother

Number of Children and ages*

Residential Address (as per Electoral Roll)

Address 1 *

Address 2

City/Town *

Postcode *

Postal Address (if different from above)

Address 1

Address 2

City/Town

Postcode

Preferred Contact Numbers

Home Phone:

Work Phone:

Mobile Phone: *

Your Email *

Questionnaire

1. List you prime areas of policy interest:*

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

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

4. Please list any educational qualifications:*

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

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

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

8. 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?:*

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

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

11. 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):*

12. 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):*

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

14. 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:*

15. Have you any other comments/information you would like to provide that may assist with your application to being preselected by Federation Party Australian Capital Territory for your nominated seat?:*

I (your full name),*
declare:

The answers I have given above in my application to be a candidate for the Federation Party Australian Capital Territory are true and correct in all respects;

I am registered on the Electoral Roll at the address provided;

I will provide a recent 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 enter into a Candidate’s Agreement.

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