Expressions of Interest
Please complete this form to express your interest to be a member of the Northland Health Consumer Council. Applications received will be put forward to a selection panel for consideration. A short list of applicants will be interviewed.
Organisation Details (if nominated by an organisation)
Nominators Contact Phone
Why are you interested in being on the Consumer Council?
What consumer experience would you bring to the Consumer Council?
Tell us a little about yourself
Particular Health Interests:
Note: All successful candidates will be required to undergo New Zealand Police clearance.
This clearance is subject to the Criminal Records (Clean Slate) Act 2004. For more information on the exception contained in Section 19(3)(e) of the Criminal Records (Clean Slate) Act 2004 please visit
Have you ever been convicted of a criminal offence?
You will be asked to sign your application if interviewed
I declare that to the best of my knowledge the answers provided in this expression of interest and any other information provided to Northland District Health Board in support of my nomination is correct and I understand that if any false or deliberate misleading information is given, or any material suppressed, I will not be accepted.
Please indicate if you are happy for our name to remain on our list of volunteer consumers to be contacted to participate in future Consumer Councils, other consumer groups or activities such as consumer workshops or patient experience interviews.
Send me a copy of my responses
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