Candidate Expression of Interest (VIC)

PERSONAL DETAILS

Surname

Given Names

Are you enrolled to vote in Victoria?

Enrolled Address

Street Address Address Line 2 Suburb State/Territory Post Code

Do you have a different postal address?

Postal Address

Street Address Address Line 2 Suburb State/Territory Post Code

Home Phone

Mobile Phone

Age

Date of Birth

Country of Birth

Occupation

Are you of Aboriginal or Torres Strait Islander origin?

Do you come from a culturally or linguistically diverse background?

Disclosures

Legalise Cannabis Victoria respects the privacy of potential candidates however there are some matters relating to the personal and financial affairs of candidates that do require disclosure.
These do not necessarily rule you out as a candidate, but we need to be aware.

Do you have a criminal record?

Have you ever been bankrupt?

Have you been investigated by the ASIC, ATO or similar?

Do you have a financial interest or shareholding in any company or enterprise that could be perceived as a conflict of interest?

Are there any other issues in your past or present that if it were made public could be damaging to the Party?

If yes to any of the above, please provide some details.

Have you ever been a member of another political party?

Please provide more details in relation to the "Yes" reponse to the previous question

Are you a current Legalise Cannabis party member?

Do you hold any office under the Australian government or the government of a State or Territory or any government authority or Agency or local government or are you employed by any of the above?

Are you currently, or is there any possibility that at the time of nomination or on election day you will be under sentence, or subject to be sentenced, for any offence punishable under the law of the Commonwealth or of a State by imprisonment for 5 year or longer?

Please provide a bio of no more than 150 words below

List social media accounts and websites you have been or are involved in.

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