Nomination Form

* Required

Main Contact Details

First Name Required

Last Name Required

Job Title Required

Company Name

Address for Correspondence

Mobile Phone Number

Home Telephone Number

Work Telephone Number

E-Mail

Date of Birth

Organisation Address

Entry Details

Overview of the Nominee Required

Describe your current role as an IT professional.

Nominees citation in support Required Describe why you believe you should be considered for ACS QLD Young IT Professional of the Year.

Nominees goals Required

Describe your future aspirations as an IT professional?

If you become a Finalist your details may be made available to other ACS sources for publicity purposes. Please select Yes if you do not want to be included

Additional Information Required

Upload CV

You must attach your CV as a supporting document with the nomination form.

Supporting Documents Required

Supporter Declaration – optional but if given the references may be followed up

Please provide up to three (3) referee’s. Referee’s will be contacted to determine if your nomination is worthy of consideration for an Award.

Referee 1

Referee Name Required

Organisation Required

Position held Required

Phone Number (BH) Required

Mobile Phone Number

Fax Number

E-mail Required

Referee 2

Referee name Required

Organisation Required

Position held Required

Phone Number (BH) Required

Mobile Phone Number

Fax Number

E-Mail Required

Referee 3

Referee Name Required

Organisation Required

Position held Required

Phone Number (BH) Required

Mobile Phone Number

Fax Number

E-mail Required

Declaration

I have read the terms and conditions and agree to abide by them. I will supply such further information as the judges may reasonably request and confirm that, to the best of my knowledge, the information given in this entry form is accurate and I am authorised to disclose it.

Declaration Required

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Nomination Form

Main Contact Details

Entry Details

Upload CV

Supporter Declaration – optional but if given the references may be followed up

Referee 1

Referee 2

Referee 3

Declaration

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