FORM C SENIOR EXECUTIVE SERVICE NOTIFICATION OF INTERCHANGE

Senior executive service: Notification of interchange arrangements

Form C

Current agency	<insert here>
Substantive role title		<insert here>
Interchange role title (including organisation address)		<insert here>

If interchange arrangement is within the Queensland Public Service

SES level	<insert here>		Assessed work value (high, low, NA)			<insert here>		Position number		<insert here>
Remuneration package point				<insert here>
Interchange arrangements		Start date			<insert here>		Finish date		<insert here>

Please include the following documentation for notification:

Interchange role description (including organisational chart)		Nominee’s curriculum vitae	

___________________________________ ______________

Agency chief executive officer Date

FOR PUBLIC SERVICE COMMISSION USE ONLY

UNDER THE AUTHORITY OF THE PROVISIONS OF SECTION 110 OF THE PUBLIC SERVICE ACT 2008, I HEREBY APPROVE THE ABOVE APPOINTMENT.

PUBLIC SERVICE COMMISSION CHIEF EXECUTIVE

FOR PUBLIC SERVICE COMMISSION USE ONLY

Noted by:

_______________________________________ ______________

Public Service Commission Chief Executive Date

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