IN CONFIDENCE WHEN COMPLETED



Application to: Grampian NHS Board

Application for appointment as a: Non-Executive member

Please note Part A of the application form will notbe made available to the selection panel.

Your form will be photocopied/scanned and then read by the panel. It is therefore important that it is legible. Please complete this form electronically, or if handwritten, in black ink.

PART A: PERSONAL INFORMATION
Last Name: / Title:
First Name(s):
(please underline the name you are known by)
Home Address:
Post Code:
Telephone number: / Mobile:
Email:
Address for Correspondence (if different from above):
Post Code:
Telephone number:

PART A: DECLARATION

I declare that the information I have given in support of my application is, to the best of my knowledge and belief, true and complete. I understand that, if it is subsequently discovered that any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified.

I understand that all documentation associated with an appointment round will be held by the Scottish Government for two years following the announcement for audit purposes and/or to investigate a complaint. I understand that if my application is successful, it will be held for the duration of my appointment. I agree that documentation generated during this appointment round may be accessed by the Commissioner for Public Appointments in Scotland or anyone acting on the Commissioner’s behalf, insofar as is necessary to ensure a fair appointment process.

Under the terms of the Data Protection Act 1998, I agree that the information given in the personal information section of the application form may be processed to provide management information for appointment round monitoring purposes. I understand that my personal details will not be made available publicly unless I am appointed.

Signature______Date

If your application is submitted by email please leave the signature blank. You will be required to sign this application if successful

Closing date for receipt of applications is on or before FRIDAY 6AUGUST 2010.

Completed applications must be returned to Brian Nisbet in the Scottish Government

You can post or faxyour application to:

Brian Nisbet

Scottish Government

Health Board Election Team

2E-S St Andrews House

Regent Road

Edinburgh

EH1 3DG

Alternatively you can return them electronically to :

PART B: SELF ASSESSMENT – SUITABILITY

This part of the application form will be available to the Selection Panel.

Please study the Skills and Personal Qualities within the Person Specification section in the accompanying booklet. Use this form to show that you have the skills and personal qualities we have asked for. Address all of the criteria sought at each section using specific evidence to support your statements. Draw on examples from your working life, through your participation with a private, public, voluntary or community organisation, and/or other areas of your personal life.

This is a very important part of your application. If you do not deal with all of the essential criteria (and desirable criteria where possible) the selection panel will find it difficult to assess your application and may be unable to invite you to interview. The selection panel will not make assumptions – for example from a job title – as to the skills and knowledge you have gained.

Each answer should address all of the essential criteria listed. To be considered for interview, you must as a minimum requirement meet all of the essential criteria listed on the following pages.

Suggested preparation

  • Take time to think about each of the criteria.
  • Think about the situations you have recently been involved in.
  • Think how your actions/experiences in these situations demonstrated the criteria.
  • Prepare your answers, answering all the questions listed under each criterion.

Writing your examples

  • Do not feel restricted in only using the space available in providing your examples. If applications are handwritten, please include continuation sheets as necessary. Nonetheless, applicants should ensure their answers are clear and to the point as possible. You may be asked to expand on your answers at interview.
  • Please ensure that you provide specific exampleswhich best demonstrate your skills, knowledge or abilities in that area, but try to use different examples across the range of criteria to demonstrate a range of experience.
  • In each statement, please feel free to draw on more than one illustration or example so that you demonstrate your abilities in each of the criteria sought.
  • Please describeactual events rather than a generalised description of what you would usually do.
  • Write what YOU did – use “I” not “we”.
  • Give the outcome – what happened?
  • Where knowledge is required, describe how you gained and/or used this knowledge.

Please confirm that your main residence or

main place of workingis in the area served by the

Grampian NHS Board YES

Please confirm that you are age 16 years or over YES

Please confirm that you would be willing to undergo a Disclosure Scotland check, should you be appointed to the Grampian NHS Board.

YES

Statement 1: In this section we will be testing the essential criterion from the person specification that is listed below. You can draw on more than one illustration or example in your answer, but should ensure that you provide specific evidence of your ability in the following area:

  • ability to examine and review complex issuesand reach your own conclusions

Please describe an experience which demonstrates your ability to examine and review complex issuesand reach your own conclusions

Statement 2: In this section we will be testing the essential criterion from the person specification that is listed below. You can draw on more than one illustration or example in your answer,but should ensure that you provide specific evidence of your ability in the following area:

  • be able to demonstrate that you can work effectively in a team or group environment to deliver results.

Please describe your experience in a way which demonstrates your ability to work effectively in a team or group environment which has to deliver results.

Statement 3: In this section you may want to highlight how you might meet any one or more of the desirable criteria listed in the person specification:

  • be able to challenge constructively and influence decision making in a group.

Please describe a time when you have had to challenge constructively and influence a decision made in a group.

PART C: LIFE HISTORY

This part of the application form will be available to the Selection Panel.

This is also a very important part of your application. When completing this section, you should refer to the accompanying Person Specification.

This section provides you with the opportunity to highlight positions held - either from your working and/or personal life, or through your participation with a private, public, voluntary or community organisation – which have provided you with skills and knowledge relevant to this role.

LIFE HISTORY: Please provide details of role(s) held; give a brief description of your duties; and highlight how the role has provided you with skills and knowledge which match any of the essential or desirable criteria listed in the person specification.
Please note that positions listed which do not also provide evidence of practical application which relate to the criteria cannot be considered.

Conflict of Interest

Are you aware of any possible conflict of interest which might arise either personally, in relation to your employment or in relation to your connections with any individuals or organisations should you be appointed?

Conflicts of interest are not normally a barrier to appointment as long as they are appropriately managed and/or resolved and this will be explored at interview. The OCPAS leaflet on public appointments which is part of the full application pack provides more guidance on conflict of interest.

Yes No

If yes, please provide details:

1