Step 1 of 4 25% Personal informationTitle*First name*Surname*Address*Post code*Email address (this needs to be provided for the safe receipt of your form)* Home phone*Mobile phone*Have you had any previous contact, or do you have any current contact with the YMCA?*YesNoIf Yes, please give details Education, training and developmentPlease list your academic and other relevant qualifications (and dates passed) starting with the most recent*Please describe other relevant learning opportunities (eg. training courses)Employment historyPlease list a summary of your employment history to date including positions held, dates of employment and an outline of your responsibilities/achievementsOther skills and experiencePlease give details of any relevant skills or experience gained outside employment (e.g. through voluntary services)Supporting informationWhy do you wish to become a Trustee for YMCA East Surrey?* ReferencesPlease supply full contact details of two people who will provide a reference for you. Please do not supply both from the same place of work or education. Referees may not be members of your family. If you were known by a different name, please also state this.Referee 1Name: Position: Address: Post Code: Email: Telephone No: In what capacity does this person know you?May we contact this person now?*YesNoReferee 2Name: Position: Address: Post Code: Email: Telephone No: In what capacity does this person know you?May we contact this person now?*YesNo Declaration of eligibility to become a charitable TrusteeI declare that I am not disqualified from acting as a charity trustee and that (please tick to confirm and agree each statement below):*I am not incapable of acting by reason of mental disorder within the meaning of the Mental Health Act 1983.I do not have an unspent conviction relating to any offence involving deception or dishonesty. Because of the nature of the role you are applying for, you are required by the Rehabilitation of Offenders Act 1974 to declare all criminal convictions including those which are spent. Please detail therefore any such convictions in the space below (A conviction will not necessarily be a bar to obtaining a position with this organisation)If no, please provide further details below.*I am not an undischarged bankrupt nor have I made a composition or arrangement with, or granted a trust deed for, my creditors.*I am not subject to a disqualification order under the Company Directors Disqualification Act 1986 or to an order made under section 429(b) of the Insolvency Act 1986.*I have not been removed from the office of charity trustee or trustee for a charity by an Order made by the Charity Commissioners or the High Court on the grounds of any misconduct or mismanagement nor am I subject to an order under section 7 of the Law Reform (Miscellaneous Provisions) (Scotland) Act 1990, preventing me from being concerned in the management or control of any relevant organisation or body.*I am not subject to a disqualification order under the Criminal Justice and Court Services Act 2000.*I am not disqualified under the Protection of Vulnerable Adults List.* I understand that if my application is successful I will be required to obtain a DBS Disclosure at the appropriate level. General Data Protection RegulationIn accordance with the Data Protection Act 1998, the information provided on this form will be used in the recruitment and selection process and may be disclosed to all those who need to see it. It will also form the basis of the confidential personnel record of the successful candidate. In the case of unsuccessful candidates the information will be destroyed after twelve months. In addition, it will be held on a database and used for equal opportunities monitoring purposes.* I confirm that I do not object to the information collected on this form being transferred onto computer for the purpose of anonymous statistical reporting, in accordance with statutory requirements and for the basis of compiling correspondence and to assist YMCA East Surrey in equal opportunities monitoring in respect of Trustee applications. Declaration (please read carefully)I confirm that the information supplied in this application form is true and accurate to the best of my knowledge. I understand that to knowingly give false information, or to omit any relevant information, could result in the withdrawal of any offer of appointment, or my dismissal at any time in the future, and possible criminal prosecution.Full name*Date (DD/MM/YYYY)*Captcha
