ADULLAM HOMES HOUSING ASSOCIATION LIMITED

Voluntary Board Member

APPLICATION FORM

Please specify by ticking the post applied for below:

Chair ¨ Vice Chair ¨ Board Member ¨

Name : ______Date of Birth: ______
Address : ______
______
______
Postcode: ______Email : ______
Telephone Details
Home : ______Business : ______Mobile:______
Fax : ______
1.  Tell us in your own words why you want to become a Board Member of Adullam.
2a. Skills and Experience:
If admitted as a Board Member, I would bring the following expertise and experience to the Association (please tick those that apply).
o  Housing needs that Adullam aims to meet
o  Residents’ needs and concerns
o  Strategic management in a public or private body
o  General business skills including human resource management
o  Finance
o  Legal matters
o  Community and economic development
o  Working with local authorities
o  Property development and building
o  Marketing/public relations
o  Fundraising
o  Training and education
o  Employment
o  Research
o  Urban regeneration
o  Criminal justice system
o  Other ______
2b. With reference to the Job Description and Personal Requirements, what qualities and/or experience do you think you could bring to the role? (continue on separate sheet if necessary)
3.  Are you now, or have you ever been, involved in any other voluntary group or society:
(Please tick)
Yes ¨ No ¨
If Yes, please give details.
4.  Are you able to work within the Christian ethos of the Association? (Please tick)
Yes ¨ No ¨

Data Protection Act 1998

This information or data which you have supplied on this form will be processed and held on computer and will be used for recruitment and selection purposes only.

I declare that the above information is accurate, and complete, and that any untrue or misleading information, will give the employer the right to reject my application, to withdraw any employment contract offered, or if employed, to dismiss without notice.

Signed: ______Date: ______

Please return this application to:

Trevor Palfreyman

Chief Executive Officer

Adullam Homes Housing Association Limited

Walter Moore House, 34 Dudley Street, West Bromwich, B70 9LS

Adullam Homes Housing Association Ltd is a member of the National Housing Federation

Registrations – Homes and Communities Agency LH 1388 - Community Benefit Society Number 20853R

Page 1 of 3