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Australian Education Union ACT Branch
Nomination Form for OH&S WORK SAFETY REPRESENTATIVES
The nominee must be nominated by at least two eligible members of the same Worker Consultation Unit. Term of Office: March 2010 March 2012.
Nominations should be forwarded to Pam Nicolson, Returning Officer, AEU ACT Branch, at the address shown below up to but not later than 4:30pm on Friday 12 March 2010. Nominations can also be faxed to the AEU Office at the number below.
ADDRESS FOR LODGING NOMINATIONS:
By Hand By Post or Facsimile
Australian Education Union ACT Branch PO Box 3673
40 Brisbane Avenue Manuka ACT 2603
Barton ACT 2600 Facsimile: 6273-1828
Telephone: 6272-7900
We, the undersigned members of the Worker Consultation Unit, hereby nominate:
Nominees Name:________________________________________________________
Worker Consultation Unit:________________________________________________
for the position of: Representative Deputy Representative
Please indicate which Union you belong to: AEU CPSU Other
Please indicate whether you require OH&S training: Yes No
NOMINATORS: (Please use block letters)
Name (in full) Signature Date
1. ____________________________________________________________________
2. ____________________________________________________________________
NOMINEES ENDORSEMENT:
I, ____________________________________________________________________
being a member of the Worker Consultation Unit, hereby accept this nomination.
Postal Address: _________________________________________________________
________________________________________________Postcode: _____________
Telephone No: Workplace ___________________ Private ___________________
Email Address: _________________________________________________________
Signature: _______________________________________Date: _________________
Please ensure that the two Nominators and the Nominee have all signed the form.
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