Supplementary Trustee Application Form

Full Name
Address (Resident)
Email address
Telephone
Mobile
Place of work
Have you been a charity trustee before? Please name
  1. To be eligible and suitable as a charity trustee in England and Walesyou must fulfil the following requirements

-Ido not have an unspent conviction for an offence involving dishonesty or deception •

-I amnot currently declared bankrupt (or subject to bankruptcy restrictions or an interim order)

-I do not have an individual voluntary arrangement (IVA) to pay off debts with creditors

-I am not disqualified from being a company director

-I am not subject to an order made under section 429(2) of the Insolvency Act 1986

-I have not previously been removed as a trustee by us, the Scottish charity regulator or the High Court due to misconduct or mismanagement

-I have not been removed from management or control of any body under section 34(5)(e) of the Charities and Trustee Investment (Scotland) Act 2005 (or earlier legislation)

-I am not disqualified from being a trustee by an order of the Charity Commission under section 181A of the Charities Act 2011

-I am 16 years or older.

Please tick to confirm that you meet the above requirements Yes No

  1. Conflicts of Interest(please tick)

Have you or any organisation you are member of, or have a pecuniary interest in, ever applied for or received a grant or been a beneficiary of the Charity? Yes No

Do you have any connection to the best of your knowledge with a tenant, sub-tenant, resident or staff member of the Charity? Yes No

To the best of your knowledge, have you, a family member or employer, done work for or supplied goods or services to the Charity? Yes No

Please list any other potential conflicts of interest that you are aware:

  1. Declaration of willingness to be appointed:

I declare that the information I have given is true and correct and I am willing to be appointed. I am aware that the information given above will be made available to the Charity’s Board of Trustees and ChiefExecutive.

Signature......

Date……………………………………………………………….

Please send this with your CV, covering letter and equalities monitoring form to:

Martyn Craddock, United St Saviour’s Charity, St Saviour’s House, 39-41 Union Street, London SE1 1SD

Using your personal information

United St Saviour’s Charity, as data controller, will use your personal information to help us recruit Board members. We will use your information to assess and progress your application and suitability for the role. If you are successful, your information will be usedas part of the screening process, to communicate with you and send you information.

We may share your information internally, particularly to other Board members and employees. If you are successfully recruited, we may also need to share your information with certain external third parties including:our bank and investment manager, suppliers who undertake background screening on behalf of the bank (credit checking agencies, criminal checking bureaus, etc.) and other third-party suppliers (or potential suppliers), who provide services on our behalf.

If you are considered suitable to join the Board, your information will be kept up to the time you are appointed to join the Board, and then throughout the term of office. If you are not selected to join the Board, your information will be securely disposed after 6 months. Whilst we retain your information you have right of access to one’s own personal data, right of correction, erasure and to object to processing, and the right to lodge a complaint with the ICO.

Charity registration number 1103731 Company registration number 5092710