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About You...
Your Relevant Organisational or Life Experiences...

Please provide details of relevant positions or experiences

Your Relevant Educational, Technical or Professional Qualifications...
Your Membership of a Professional Regulatory Body...

If you are a member of a regulatory body such as the NMC, GMC, CIPD etc please provide details

Your Personal Statement...
Your Agreements...

I am not disqualified from being a charity trustee in terms of the 2005 Act, as amended by the 2023 Act – that is:

o   I am not an undischarged bankrupt

o   I have not granted a Protected Trust Deed (PTD)

o   I do not have an unspent conviction

o   I am not subject to a bankruptcy related measure

o   I do not have an unspent conviction for an offence under the 2005 Act

o   I have not been removed by the Court of Session under the 2005 Act (or earlier legislation) from being a charity trustee or being concerned in the management or control of any charity or body

o   I have not been removed from being a charity trustee by the Charity Commission or the High Court in England due to misconduct or mismanagement

o   I have not been subject to a disqualification order or disqualification undertaking made by the CCEW under section 181 of the Charities Act 2011 disqualifying me as a charity trustee

o   I have not been found guilty of contempt by a Court in England and Wales in civil proceedings for making a false disclosure statement

o   I have not been removed as a charity trustee or trustee of a charity by the Charity Commission for Northern Ireland (“CCNI”) or the High Court in Northern Ireland due to misconduct or mismanagement.

o   I have not been found guilty of disobedience to an order or direction of CCEW or CCNI on an application to the High Court in England or Northern Ireland

o   I have not entered into an individual voluntary arrangement (IVA) to pay off debts with creditors. (This only applies to trustees living in England, Wales or Northern Ireland)

o   I am not disqualified from being a company director.

o   I am not a designated person under the anti- terrorist legislation

o   I am not subject to the notification requirements of Part 2 of the Sexual Offences Act 2003 (on the sex offenders register).

Equal Opportunities
We are committed to the fair treatment of everyone, regardless of race, gender, religion/belief, sexual orientation, age, pregnancy/maternity, marital or civil partnership status, physical/mental disability, responsibilities for dependents or offending background.

The information you give on this form will help us ensure equality in our services to you. We recognise that you may regard some of this information as personal and we have, therefore, included an option in most questions for ‘prefer not to say’.

All information that we collect in relation to equality and diversity will be treated confidentially in accordance with the Data Protection Act 2018 and will be stored within the Applicant Tracking System. Access to this information will be restricted to staff involved in the processing and monitoring of this data. It will be used to provide statistical information only. In completing the form below, you consent to us using your data for this purpose.

If you have a medical condition, the Equality Act 2010 requires employers to make reasonable adjustments to the job content or working environment. To achieve this, we need to know whether you are covered. Definition of Disability: “A physical or mental impairment which has a substantial and long-term effect on a person’s ability to carry out normal day-to-day activities in a non-work environment.”

There are 6 million carers in the United Kingdom and nearly one in eight workers are carers. With an ageing population and an expected increase of 60% of carers in the next 30 years, we would like to monitor the number of people with caring responsibilities.