Please submit a short curriculum vitae together with this application form. Please note that this is in addition to the information given on the application form, not in substitution for it.
Name:
Address:
Date moved into current address:
Previous address if less than 3 yrs. at current address:
Telephone Number:
Email:
Date of birth:
Nationality:
Do you have previous Trustee experience?
If yes please provide details
Please tell us how you fulfill the criteria
In each section below, please give a brief outline of how your skills, knowledge, experience and qualifications fit the criteria.
Please give demonstrable examples wherever possible to support your application.
Skill/expertise/ knowledge/ qualification / How would you contribute your skills, experience or qualification to the Board?
Board/committee experience
leadership & facilitating meetings
Business strategy planning
Change management
Charity/Voluntary organisation governance
Employment law
Finance/ Budget management
Marketing, PR & Fundraising
Health and Safety
Influencing skills
Knowledge of local community
Legal (including Charity & Company Law)
Risk Management
Why do you want to be a trustee?
A diverse board can reflect and support the delivery of the mission of an organisation.
Do you have specific skills, work experience, social or family experience; background or general interests that will help us better support the goals of the organisation?
Are there any areas of the charities work you have an interest in and/or would like to become more involved?

References

Please give the name and address of two referees who can comment on your suitability for this role. Please note references from relatives are not acceptable.

Reference One / Reference Two
Name
Position
Organisation
Address
Telephone
Email

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Declaration

I confirm that the details given in this form are correct and understand that any false declaration may result in my removal from the board of trustees as outlined in the Charites Articles of Association.

By completing and signing this form, you declare that:

  • You are aged 18 years or over at the date of this election or appointment
  • You are willing to act as a trustee of the organisation named above

Also, that you are not prevented from acting as a trustee because you:

  • have an unspent conviction for an offence involving dishonesty or deception
  • are currently declared bankrupt (or subject to bankruptcy restrictions or an interim order)
  • are disqualified from being a company director
  • are disqualified from being a trustee by an order of the Charity Commission under section 181A of the Charities Act 2011
  • are disqualified under the Protection of Vulnerable Adults List
  • are subject to an order made under section 429(2) of the Insolvency Act 1986

I will, if elected, undertake a Disclosure and Barring Service check

Signature……………………………………………………………… Date………………………………………………………….

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