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Recognition of Service to Local Government Online Form

* Mandatory Field

Recognition of Service to Local Government

Recipient Details

Title*
Name of person to receive award*

(Please add full name to be printed on certificate)

Council Name*
Month and Year commenced in Local Government*

(MM/YY)


Local Government Service Categories

There are three types of Service Categories.

  1. Certificate of Service: Council Members - Recognition of 20, 25, 30, 35 or 40 years service

  2. Service to Local Government: Council Members - Recognition of combined term of service of more than 20 years as both a Council employee (staff) and as a Council Member

  3. Local Government Service Award: Recognition of Council Members who have served 10 -15 years OR recognition of Council staff who have served 10+ years.

Further information on the Local Government Service Catergories can be found at: www.lga.sa.gov.au/MeritAwards. (Note, open link in a separate window to avoiding losing details inputted into this form.)

LG Service Categories*
Service period to be recognised*
Please indicate if the receipient has served as:*
Please indicate if years of service have been:*
If you selected the option combined service as Council Member and Staff member above, please specify service for each:

Please write above the length of service as 'Council Member: Commenced __/__/__ to __/__/__ or ongoing' and as a 'Staff member: Commenced __/__/__ to __/__/__ or ongoing'


Presentation of Certificate

  • The Certificate of Service and Service to Local Government Awards for Council Members who have served 20 years or more are presented before an audience of the recipient's peers at either the LG Showcase Dinner (held in conjunction with the Ordinary General Meeting in April), or at the LGA AGM Dinner (held in conjunction with the Annual General Meeting in October) each year.
  • Please note that certificates are presented during the networking dinner of the AGM or OGM following the conclusion of the relevant term of service.
  • The LGA will  book in and subsequently mail out an invitation to the Council to on-forward to the nominated Council Member to these events. This letter will contain confirmation details and an invitation to the relevant dinner the presentation will be made at.
  • If the options listed below don't fit your nominees eligibility criteria then please select the 'other' options you'll see in the drop down selections below. Then once all these fields have been filled in please fill in rest of the form.
  • The Local Government Service Award is posted to Council to present directly to the recipient. Councils can request that a Senior LGA Officer to attend the presentation at their nominated meeting, date and location.
  • The LGA needs to know the date, time and location of the presentation regardless of whether or not a Senior LGA Officer will be requested to attend the presentation.

Please select (below) the relevant category and the preferred event.

Preferred LGA Event*

Please outline the person nominated key achievements and any other key information that will help inform the presenter about the nominated persons service to Local Government and the community they serve within.

Short Bio about the person

Please outline the person nominated key achievements and any other key information that will help inform the presenter about the nominated persons service to Local Government and the community they serve within.

Require a Senior LGA Officer present or not*

Do you require a Senior LGA Officer to attend the presentation

Meeting Name:
Meeting Date and Time:
Meeting Location:
Date certificate required

(if the certificate is to be posted to your Council for presentation)


Key contact person

Contact person lodging this form*
Contact email address*
Contact Phone Number*
-
Other comments

Please provide any other information about your nomination that may assist the LGA to assess this application.

If you see this, leave this form field blank.

Send a copy of the submitted form to this email address.

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