Application Form

Campaign Reference (can be found within the advertisement)
Establishment
(see Note below)
Other Establishment(s) of Interest
(see Note below)
Note:
·  If the advertisement you are responding to refers to one establishment only, you should enter this location only in the Establishment box above
·  If the advertisement is for two or more IMBs, you should enter your preferred location in the Establishment box. Any other preferences from the establishments listed in the advertisement can then be entered in ‘Other Establishment(s) of Interest’ box
·  You should normally live within approx 20 miles of the IMB you are applying to, unless another distance is specified within an individual advertisement
·  You should only apply for one IMB recruitment campaign at a time and not submit multiple applications for different Boards until the outcome of the first is known
·  If you are a former IMB Member applying to re-join the IMB, there must be a 3 year gap before an application can be made to rejoin any previous IMB on which you served; however, you can apply to any other IMB without restrictions.
·  All fields are mandatory; if a section does not apply to you, please do not leave blank but write ‘Not applicable’. Incomplete forms may not be considered

Section A – About Yourself

Family Name
Title (Mr/Mrs/Ms etc.)
Full Forenames
Previous Family Name(s)
Town, County and
Country of Birth
Nationality
National Insurance Number
Current Home Address
Postcode
Contact Telephone Number
Email address
How much time are you able to volunteer per month
Have you been resident in the UK for the past 3 years? / Yes / No

If you answer ‘Yes’ to any of the next three questions, please give details in the box below

Are you subject to immigration control? / Yes / No
Are there any restrictions on your continued residence or
employment in the UK? / Yes / No
Have you spent more than 6 months in total out of the UK
in the last 3 years? / Yes / No

If you answered ‘Yes’ to any of the last three questions, please give details in the box below

Note: Since security (Disclosure Barring Service - DBS) checks cannot cover any period of time that a candidate has lived abroad all candidates who have lived abroad for more than six months in the last three years are required to produce a Certificate of Good Conduct from that/those country/countries. Please note that this is any period of time totalling six months not necessarily six consecutive months. Responsibility for obtaining certificates of good conduct including any financial costs incurred falls to you as the candidate.

Section B – Employment

Please provide details of any paid employment you have had in the past five years or your last two jobs. Please indicate if you are retired and provide details of your last role whilst in employment.

Employer / Position held / Nature of work / Dates Employed

d

Section C – Activities not related to employment including any volunteering roles

Please provide details ofactivities and interests and volunteer roles that may be of relevance to your application, give details below and explain any abbreviations used.

Activities and interests / Nature of activities and interests / Dates

Section D Ministerial and/or Public Appointments

Is this your first public appointment?

Yes / No

Please give details of any Ministerial and/or Public Appointments already held with dates of appointment.

Public or Ministerial Appointment / Nature of Appointment / Date of Appointment

If you were previously appointed to an Independent Monitoring Board, please provide the name of the Board and the dates and explain the reason for leaving. Please also indicate the length of service by providing the dates you served on the IMB below.

Name of IMB / Reasons for Leaving / Dates

Section E – Convictions

The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 applies to applicants for, and members of Independent Monitoring Boards. This means that you must provide details of any convictions and cautions (spent or unspent) that you may have other than protected convictions or cautions. This link takes you to the DBS website for information on protected and unprotected cautions and convictions – www.gov.uk/government/uploads/system/uploads/attachment_data/file/266123/Filtering_guide-v2.3.pdf. https://www.gov.uk/government/collections/dbs-filtering-guidance See also the accompanying notes for further guidance on protected cautions and convictions.

If you are convicted of a criminal offence or are the subject of any court order after you have completed the form, and while your application is still under consideration, you must notify the IMB Secretariat. This may not invalidate your application.

If you answer ‘Yes’ to any question in this section, please provide full details, including dates of when you were on probation, received a conditional discharge or were bound over after being charged with any offence and the location where it occurred in the box at the end of this Section. This may not invalidate your application.

Community Sentences

Are you subject to a community order, on conditional discharge, or bound over, after being charged with any offence? / Yes / No
Actions Pending
Have you been charged with any offence which is still pending? / Yes / No
Cautions
Have you ever received a caution or a conditional caution? / Yes / No

If you answered ‘Yes’ to any of the questions in this section, please provide full details including the nature of the offence, where it occurred and the outcome.

Nature of Offence, including Location and Date / Outcome

Section F – Conflicts of interest and other information

One of the most important requirements for Board Members is that they perform their duties impartially and objectively. It is also vital that the public has confidence in the independence and impartiality of the Board. Even a perceived conflict of interest on the part of a Board member can be damaging to the Board’s reputation. All prospective Board Members will therefore be asked at interview to declare any personal direct or indirect interests, connections or obligations which could, or could be perceived to, influence their actions, decisions or judgment, or make it difficult for them to fulfil their duties fairly.

Are you related to, or acquainted with, anyone who is serving a custodial sentence in a prison or is being held in an Immigration Removal Centre? / Yes / No
Are you related to, or acquainted with, anyone who works in a prison or Immigration Removal Centre or Short Term Holding Facility? / Yes / No
Do you know anyone who is serving on an IMB,
either the Board you are applying to or another IMB? / Yes / No
Do you have any direct or indirect interest in any contract for the supply of goods or services to a prison or Immigration Detention Centre or any other interests which might give rise to a conflict, or a perceived conflict of interest? (please refer to the enclosed document for further information) / Yes / No

If you answered ‘Yes’ to any question in this Section, please provide further details below

Section G – Political Activity

These questions are asked for two reasons:

• Involvement in political activities enables individuals to gain and to demonstrate skills and experiences they may not otherwise have obtained; and

• It enables the monitoring of political activity of candidates for a public appointment in so far as it is already in the public domain. Neither activity nor affiliation is a criterion for appointment (except where statute dictates specific representation).

The activities listed below may provide an opportunity to demonstrate skills and experience which might be useful in the appointment for which you are applying and may give you the opportunity to demonstrate commitment for the appointment.

Please indicate which of the following activities you have undertaken during the past five years by ticking the appropriate box and providing details of your involvement. Name the party or body for which you have been active. If you have been or are an “Independent” or have sought or obtained office as a representative of a particular interest group, you should state this. You should tick all relevant categories.

None of the following activities apply
Obtained office as a Local Councillor, MP, MEP etc
Stood as a candidate for one of the above offices, have spoken on behalf of a party or candidate
Acted as a political agent
Held office such as Chair, Treasurer or Secretary of a local branch of a party
Canvassed on behalf of a party or helped at elections
Have undertaken any other political activity which you consider relevant
Made a recordable donation to a political party1

Please provide the name of the political party that your activity relates to:-

1The Political Parties, Election and Referendums Act 2000 requires the Electoral Commission to publish a register of recordable donations (donations from any individual totalling more than £5000 in any calendar year, or more than £1000 if made to a subsidiary accounting unit such as a constituency association, local branch, women’s or youth organisation). These provisions became effective from 16 February 2001.

Section H – How did you hear about Independent Monitoring Boards?

Please indicate how you found out about the Independent Monitoring Boards. Please specify names of websites, newspapers, events or name of existing Member who gave talks etc

Name of website or place or publication or place where you FIRST saw these vacancies advertised
IMB website
Reed website
Cabinet Office Public Appointments website
Third Sector website
Through a Google search
Other website (eg Reach Skills, Clinks, Do-It)
Newspaper article or advert
Leaflet or Poster (please specify where you saw this)
Exhibition or Presentation by IMB
Other Organisation or event
(please specify which organisation)
Volunteer Centre
Word of Mouth (please specify if by an existing IMB member)
Other (Please provide details)

Section I - Guaranteed Interview Scheme Declaration

I consider myself to have a disability as defined under the Equality Act 2010, and I would like to apply under the Guaranteed Interview Scheme. / Yes / No
Do you require any special arrangements to be made to enable you to attend or undertake a familiarisation visit or interview? / Yes / No

If yes, please provide further details in this box:

Section J – Competencies

Finally, we would like to know a little more about you and what you could bring to the role as an IMB Member. Using the blank space below and overleaf and referring to the following competencies, please tell us about yourself. To do this, you might find it helpful to read the competencies section within the ‘Guidance on Completing the Application Form’ leaflet. You may also find it helpful to refer to the ‘Useful Information’ leaflet and other information on the IMB website for further background about the IMB.

Ø  Communication

Ø  Objectivity and Analytical Skills

Ø  Understanding Equality and Diversity

Ø  Teamwork and Board Development

Ø  Drive and Determination

Section K – Declaration

I have read the Guidance on completing the application form. If appointed, I will undertake the required training. The information given in this application is true and accurate to the best of my knowledge and belief. I undertake to notify the Secretariat if at any time there is a material change in the information I have given. I understand that by deliberately providing false or misleading information my appointment will be terminated.

If returning this form by email, please type in your signature and date. If returning this form by post, please sign and date the form by hand.

Signature / Date

Please return your completed application by the closing date to:

By Email:

By Post: IMB Secretariat

9th Floor, Post Point 9.52

The Tower

102 Petty France

London

SW1H 9AJ

Note: Please submit one copy only of your application form, preferably by email, but otherwise by post.

Application Form | 9