Application for Appointment to the Board of the Corporation

APPLICATION FOR APPOINTMENT TO THE BOARD OF THE CORPORATION

– GOVERNOR OR CO-OPTED MEMBER APPOINTMENT

Before completing this form please read the Guidance Notes carefully.

This form may be photocopied when it reaches the College and it would therefore be helpful if you could please complete it in black ink or complete it electronically.

personal Details

a.TitleMrMrsMissMsDrOther (specify)
Please circle one (or highlight if completing electronically)
b.Surname
c.First Name

1. Home Address

Telephone Number
Mobile Phone Number
E-mail address

1. Address for correspondence (if different from above)

Telephone Number
E-mail address

1. How many years have you lived in the locality?

1. What is your present profession/occupation? If retired please state “Retired” followed by your former profession/occupation.

1. Please describe briefly why you wish to become a Governor at City of Bristol College, having regard to the six key qualities a Governor must possess *good character, understanding and communication, social awareness, maturity and sound temperament, sound judgement, commitment and reliability) and any experience you have which may be relevant. Please continue on a separate sheet and attach, if necessary.

1. Have you visited the College? If so, when?

1. If you have ever been a member of a college governing body or made a previous application to be a member of the Corporation of City of Bristol College, please give details.

1. Please give the name of any relative, including spouse, partner and their close relatives, who are Members of the Corporation or employees of City of Bristol College. Please include details of past serving Governors and/or employees since 1993 giving details of their position held, dates of office or employment where possible.

1. Are you an employee, or a student, at City of Bristol College? If ‘Yes’ please give details.

skills

This section of the application form has been designed to capture information about you and your experience that will assist the Search Governance Committee in matching your skills and expertise with the current skills base of the governing body. A section is listed on education experience for those who have worked in a professional education role but no specific experience in education is necessary to become a Governor or Co-opted Member – the College needs Governors with a range of skills to set strategy, ensure sound financial performance, to monitor risk and develop the College as a business.
Please tick the following boxes which best reflect your abilities and experience in each area.
Key area of expertise used regularly in own profession/job / Significant area of expertise used regularly in own profession/job / Detailed working knowledge used regularly in own profession/job / Some working knowledge used periodically in own profession/job / Little or no knowledge and/or experience
SETTING STRATEGY
Broad Business Experience
Collaborative Partnerships
Community Involvement
Corporate and Strategic Management
QUALITY IMPROVEMENT
Quality Assurance Systems
Responding to Students/customers
Target Setting and performance monitoring
BUDGETS AND FINANCIAL PLANNING
Finance and Financial Planning
Economic Planning
Estates/Property
Small and Medium Sized Enterprise
Large/national/multi-national Enterprise
Accounts auditing
Key area of expertise used regularly in own profession/job / Significant area of expertise used regularly in own profession/job / Detailed working knowledge used regularly in own profession/job / Some working knowledge used periodically in own profession/job / Little or no knowledge and/or experience
HUMAN RESOURCES/EMPLOYMENT
Personnel/Human Resources
Appointing/Appraising Senior Staff
Workforce Planning
Workforce Development
BUSINESS SKILLS
Strategic Management
Equality and Diversity
Marketing
Communications
IT
Interpersonal Skills
Start-up/new enterprises
Entrepreneurial Skills
EDUCATION EXPERIENCE
Further Education / Colleges/ 6th Form
Higher Education/University
Schools
Please indicate any voluntary or community role with which you are associated
Community groups and associations / Magistrate
Community languages / Offenders/Ex-Offenders
Campaign Group for disability or health issue / Refugees/asylumseekers
Faith work, church or other religious group / Arts/theatre
School or college governor / Youth work
HE/University governor / Trade union
Local elected councillor / Member of Parliament
Other (please specify)

DECLARED INTERESTS, CONVICTIONS AND ANY CIVIL MATTERS

1. Does your employer (or ‘you’ if self-employed or former employer if you are ‘retired’) have any current or intended contractual arrangements with the College for the supply of goods and/or services that you are aware of? If so, please give details of the nature of the contract(s) and the value(s).

1. Please give details of any criminal convictions that you have, whether spent or not under the Rehabilitation of Offenders Act 1974. (Please note that it is standard procedure for all Governors, and applicants, to complete a request for disclosure with the Disclosure and Barring Service).

Please continue on a separate sheet and attach, if necessary.
Offence / Penalty or Order of the Court / Court / Date of Conviction
c.Please give details of any criminal or civil proceedings in which you are, or expect to be, a party.
d.Please give details of any police cautions to which you have been subject.
e.Have you ever been declared bankrupt on, or entered into a voluntary arrangement with creditors? If ’Yes’ please give details.
f.Have you ever been a director of a company which has been placed into liquidation or administration? If ’Yes’ please give details.
g.Are you a member of any organisation whose aims and objectives are not consistent with the College's duty to promote good race relations and to oppose all forms of discrimination? If ’Yes’ please give details.

REFERENCES

Please give details of two people who are prepared to provide a written reference in support of your application. It is expected that a referee should have known you for at least three years.
Referee 1
Titleplease indicate: MrMrsMissMsDrOther (specify)
Name:
Address:
Email address (if we may use such address):
Telephone Number:
Occupation:
Referee 2
Titleplease indicate: MrMrsMissMsDrOther (specify)
Name:
Address:
Email address (if we may use such address):
Telephone Number:
Occupation:
DECLARATIONS
Please tick either Yes or No. You may be asked this question again, if you are called for an interview.
Is there anything in your private or working life, or in your past, or to your knowledge in that of any member of your family or close friends, which, if it became generally known, might bring you or the College into disrepute, or call into question your integrity, authority or standing as a member of the Corporation?
Yes No
I have read the Guidance Notes. I wish you to consider my application for membership of City of Bristol College Further Education Corporation and confirm that I do not contravene any of the ineligibility criteria set out in the extract from the Instrument & Articles of Government provided in the Guidance Notes.
If appointed, I will be able to carry out my fair share of duties described in the Guidance Notes and undertake the required training. The information, which I have given, is true and complete to the best of my knowledge and belief.
Signed ______Date ______
(Please complete signature in block capitals if the form is being completed electronically)

The application will be treated in strict confidence and only shared with individuals who are part of the application process.

The completed application form should be sent to:

Stephen Davies

Clerk to the Corporation

City of Bristol College

PO Box 2887

Bristol

BS2 2BB

Or emailed to:

If you have any queries with your application or you require an application form or any of the supporting information in an alternative format, please do not hesitate to contact:

Stephen Davies

Clerk to the Corporation

Tel: 0117 312 5006

Email:

City of Bristol College, College Green Centre, St George’s Road, Bristol, BS1 5UA

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This page is left intentionally blank so that the following Equality and Diversity Monitoring form can be separated from the application form.

Please continue to Equality and Diversity Monitoring Form overleaf.

City of Bristol College Corporation THIS APPLICATION FORM IS

Application Form November 2014CONFIDENTIAL WHEN COMPLETED

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Equality and Diversity Monitoring Form

Why are we asking you for this information?

At City of Bristol College we are committed to promoting the health and well-being of our Governors and Co-opted Members and to ensuring all are well supported during their time with us. This information will help us to do this and to understand more about the diversity of those applying to be Governors and Co-opted Members. It will also enable Governors to set clear targets which promote the interests and opportunities of under-represented groups. We want to ensure that no one is disadvantaged when applying or carrying out their duties as a Governor or Co-opted Members.

All information will be kept strictly confidential by the Clerk to the Corporation. It will be separately stored from the record of applicants who successfully become Governors and Co-opted Members. The data will be collected together anonymously to provide overall numbers of people who are in the various categories. The questions follow protected characteristics under the Equalities Act 2010 and use census definitions where appropriate.

This sheet will be separated from your application form and the information it contains will not be used for shortlisting or at any other stage of the selection process.

1. Cultural and Ethnic Origin
A. White
English / Welsh /
Scottish/Northern
Irish/ British
Irish
Gypsy or Irish
Traveller
Any other White
background / B. Mixed/multiple ethnic groups
White and Black
Caribbean
White and Black
African
White and Asian
Any other
Mixed/multiple
ethnic background / C. Asian / Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian
background / D. Black / African / Caribbean
Black British
African
Caribbean
Any other
Black/African/
Caribbean
E. Any other ethnic group
Arab
Any other ethnic group
F.Prefer not to say
2. What is your age group?
Under 18
18 - 30 / 31 - 40
41 - 50 / 51 – 60
61+
Prefer not to say
3. What is your sex/gender?
Male Female Prefer not to say
4. What is your Sexual Orientation ?
Heterosexual
Gay man
Lesbian/gay woman
Bisexual / Questioning
Other – please specify………..
Prefer not to say
5. What is your religion, faith or belief?
No religion
Christian (including Church of England,
Catholic, Protestant and all other Christian
denominations)
Buddhist
Hindu
Jewish / Muslim
Sikh
Any other religion, please specify:
…………………………………….
Prefer not to say
6. Marriage and Civil Partnership
Are you: Married In a registered same-sex Civil Partnership Other
Prefer not to say
7. Disability
Would you describe yourself as having a disability or health problem?
Yes No Prefer not to say
If yes, please tick the relevant box below
Visual Impairment
Hearing Impairment
Disability affecting mobility
Other physical disability
Mental Health Difficulty
Multiple disabilities
Profound/complex disabilities
Other medical condition (i.e.
epilepsy, asthma, diabetes)
Emotional and/or behavioural
Difficulties
Mental Health difficulty
Temporary Disability (i.e. after accident,
illness)
Other, please specify:
………………………………………..
Prefer not to say / Would you describe yourself as having a learning difficulty?
Yes No Prefer not to say
If yes, please tick the relevant box below:
Moderate Learning Difficulty
Severe Learning Difficulty
Dyslexia
Dyscalculia
Other Specific Learning Difficulty
Autism spectrum disorder
Asperger’s Syndrome
Multiple Learning Difficulties
Other, please give details
………………………………………………
Prefer not to say
8. Health & Well-being related support needs
Do you have any health and well-being needs not mentioned earlier?
E.g. are you a carer or are responsible for family members with particular needs?
Yes No Prefer not to say
If you answer ‘yes’, you may find it helpful to discuss your needs with the Chair or Clerk to the Corporation if you are appointed.

City of Bristol College Corporation THIS APPLICATION FORM IS

Application Form November 2014CONFIDENTIAL WHEN COMPLETED

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