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Expression of Interest for the District Licencing Committee

Use this application form if you want to submit your Expression of Interest for the District Licencing Committee.

You can view the position description and further information on our District Licencing Committee page.

If you prefer to apply in writing, please download our Expression of Interest Application Form. You can also collect this from our service centres in Westport and Reefton.

Expression of Interest Form

Personal

Name

Address *

Phone number *

Are you legally entitled to work in New Zealand? *

Yes
No

Current Driver Licence held? *

Yes
No

Which classes of licence? *

If your application is accepted, would you be available to carry out the functions of a List Member of the District Licensing Committee from 18 December 2013? *

Yes
No

Privacy

The information you provide on this form may be collected and held by the Buller District Council. This information is collected for the purpose of assessing your suitability for this position, which may include subsequent changes in the position. With the exception of “evaluative material”, in accordance with the Privacy Act 1993 you have a right of access to personal information and to seek any correction you think is necessary to ensure its accuracy.