In confidence (when completed)

APPOINTMENT TO

THE ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION 2017

APPLICATION FORM

TRUSTEE

This Application Form is in four parts.

The closing date for the return of completed application forms is NOON on Thursday 28 September 2017.

Late applications will not be accepted.

Please contact the Department as soon as possible if you require the application form in an alternative format. Contact details are as follows:

Andrew Wilson 028 9052 2821 or Coral Cullen 028 9052 6569

Email:


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

RETURN DETAILS

Please return all four parts of your completed application to:

RUC GC Foundation Appointments Team 2017

Department of Justice

Policing Policy and Strategy Division

Room A4.15

Block A, Castle Buildings

Stormont,

Belfast BT4 3SG

Or deliver by hand to

RUC GC Foundation Appointments Team 2017

Department of Justice

Block B Reception

Castle Buildings

Stormont Estate

Belfast

Or email to

no later than

NOON on Thursday 28 September 2017


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

GENERAL INFORMATION

·  It is strongly recommended that you read the accompanying “Public Appointments Guide” and Candidate Information Pack before completing your application form.

·  Electronic applications are welcome and should be completed in Arial font size 12. If completing electronically, applicants must comply with the character limits that have been set for the relevant section of the form. Handwritten or typewritten applications should be legible and completed using black ink. If handwriting, please keep within the space provided for each section. Any information over and above the word count will be redacted by the Admin. Team before being submitted to the selection panel.

·  Supplementary material such as CVs, letters, or any other material in place of, or in addition to, completed application forms will not be accepted.

·  If your application is submitted by e-mail we will require you to sign Part C if invited to interview.

·  Applications will not be examined until after the closing date. We would advise you to retain a copy of your application for your own information.

·  It is your responsibility, to demonstrate clearly on your application form, how you satisfy the published selection criteria. Only those applicants who appear, from the information provided, to be the most suitable in terms of the published selection criteria will be called for interview.

·  It is essential that you provide evidence of how you meet the selection criteria, giving examples and specifying exact dates as appropriate. Remember, skills, knowledge and experience can be acquired in a variety of ways including work on a voluntary basis or a personal capacity. It is not sufficient to simply list the various posts that you have held. The selection panel cannot make assumptions as to your skills, knowledge and experience from the title of previous posts held.

·  Please note that if all sections of the application form are not completed in full, we may be unable to proceed with your application. You must restrict your examples for each criterion to the space provided. Any characters inserted outside the space provided will be redacted and will not be made available to the selection panel. The layout should not be changed or altered in any way.


SECTI

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ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

PART A: PERSONAL INFORMATION

PERSONAL DETAILS

Title (Prof/Dr/Mr/Mrs/Ms/etc.):
Surname:
Forename(s):
Known Name:
Former surname(s) (if any):
Date of Birth (dd/mm/yy):
National Insurance Number:
Permanent address:
Postcode:
Telephone no (include STD code):
Mobile telephone no:
E-mail address:
Address for correspondence (if different from above):
Postcode:


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

PUBLIC APPOINTMENTS

Please indicate below if you currently hold or have previously held a public appointment as a Trustee of the Royal Ulster Constabulary George Cross Foundation.

Yes: / No: / If yes, dates (from/to):

Please list any current public appointments you hold, giving the name of the organisation, the dates of appointment and the position(s) held.

Dates
(From / To) / Public Body / Position(s) Held
(including remuneration of any current appointment)


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

VOLUNTARY APPOINTMENTS

Please list any current voluntary appointments you hold, giving the name of the organisation, the dates of appointment and the position(s) held.

Dates
(From / To) / Voluntary Body / Position(s) Held


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

INTERVIEW ARRANGEMENTS

At this stage, it is anticipated that interviews will be held on 11 and 12 October 2017. Please detail in the box below any dates on which you would NOT be available for interview. If these dates prove unsuitable the Department will endeavour to accommodate applicants outside of this period. However, candidates should be aware that the Department will not be obliged to offer an alternative date.

Please note that if you are successful you will be required to take up appointment as advised by the Department.


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

PART B: SKILLS, KNOWLEDGE AND EXPERIENCE

Essential Criterion 1 – Governance and Management of Resources – to ensure that funds are accounted for and the organisation is managed effectively.

Please provide detailed evidence of how you meet this criterion including specific examples and dates in the box below.

ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

Essential Criterion 2 – Working in Partnership and Relationship Management - the ability to build and maintain effective working relationships with partners, to ensure the delivery of successful results.

Please provide detailed evidence of how you meet this criterion including specific examples and dates in the box below.

ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

Essential Criterion 3 – Thinking Strategically – setting the priorities and direction of your organisation, by anticipating emerging issues, analysing evidence and problem solving to ensure the organisation delivers on its functions.

Please provide detailed evidence of how you meet this criterion including specific examples and dates in the box below.


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

Essential Criterion 4 – Communication and Interpersonal Skills - highly effective communication skills, both written and oral, and the ability to listen and respond to the views, needs and concerns of a wide range of other stakeholders

Please provide detailed evidence of how you meet this criterion including specific examples and dates in the box below.

ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

Desirable Criterion – Understanding and Empathy – An understanding of, and empathy for, the work of the Foundation and of the policing family.

Please provide detailed evidence of how you meet this criterion including specific examples and dates in the box below.

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ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

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PART C: OTHER INFORMATION

PROBITY AND CONFLICTS OF INTEREST

Before you complete this section, it is important that you read the guidance on probity and conflicts of interest contained in your information pack.

Have you, your partner, your immediate family, any business or other interests or personal connections that might be construed as being in conflict with the appointment for which you have applied? Are there any other probity issues, which might cause embarrassment if, in future, they are raised in public?

Yes / No
If you answered yes, please provide details below

Any potential probity issues or conflicts of interest detailed above will not prevent you from being called for interview but may, if appropriate, be explored with you at that time to establish how you would address the issue should you be successful in your application.


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

OTHER INFORMATION

Please tick as appropriate:

Have you ever been convicted of a criminal offence (other than minor motoring offences) which is not spent in accordance with the Rehabilitation of Offenders Act 1974? / Yes: / No:
Are you the subject of any legal, criminal or statutory investigations or actions, or are any pending? / Yes: / No:
Have been adjudged bankrupt or been the subject of a bankruptcy restrictions order or had a debt relief order made in respect of you or been the subject of a debt relief restrictions order or made a composition or arrangement (such as those set out in Note 1 below) with your creditors over the past 10 years? / Yes: / No:
Were you dismissed from any public office over the past 10 years? / Yes: / No:
Have you ever been disqualified from acting as a company director or in the conduct of a company, or are under investigation in relation to a potential Directors disqualification? / Yes: / No:
Are you or have you been a director, partner or manager of a company which has gone into liquidation, receivership or administration? / Yes: / No:
If you ticked yes to any of the above please provide details below:

Note 1

Individual Voluntary Arrangements (IVAs) or Fast-Track Voluntary Arrangements (FTVAs);

Bankruptcy Restrictions Orders or Undertakings (BROs/BRUs);

Debt Relief Orders (DROs); and

Debt Relief Restrictions Orders or Undertakings (DRROs/DRRUs).


ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

DECLARATION AND SIGNATURE

I understand that a candidate found to have given false information or wilfully to have suppressed any material fact will be liable to either disqualification or, if appointed, to dismissal.

I have read the guidance provided in relation to probity issues and conflicts of interest and have completed that section of Part C accordingly. I understand that, if appointed, I must raise any probity or conflict of interest issues that might arise during my term of appointment and that my failure to do so could lead to my appointment being terminated.

I declare that the information I have given in support of my application as recorded in Parts A, B and C of this application form is true and complete to the best of my knowledge. I understand that, if I am appointed and the information I have provided is incorrect, or any of the statements made in this declaration are untrue, or subsequently circumstances arise at any time before the end of my term of office which would render any such statements untrue, then my tenure of office may be terminated.

Under the terms of the Data Protection Act 1998, I agree that the information given in all three sections of this application form may be processed to provide management information for recruitment and equal opportunities monitoring purposes. This may involve disclosing information to other Government Departments and anonymously in response to Parliamentary/Assembly Questions and other enquiries. I also understand and accept that if appointed some of the information I have provided will be placed in the public domain.

Signed: ______Date: ______

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ROYAL ULSTER CONSTABULARY GEORGE CROSS FOUNDATION

APPLICATION FORM FOR TRUSTEE

PART D: MONITORING INFORMATION

(Return with your application form)

Please ensure that you read the notes for guidance in the Candidate Information Pack before you complete this part of your application form.

The Northern Ireland Civil Service (NICS) is committed to ensuring that all eligible persons have equal opportunity for public appointments on the basis of their ability and aptitude for the role. Monitoring is carried out to help us ensure that our processes and procedures promote equality of opportunity as far as possible and therefore your help in completing and returning this monitoring form as part of your application would be appreciated. Please note the information you provide in this monitoring form will be detached from the information on the application form, held separately and will not be available to selection panels or to anyone else involved in the selection process. The information will be used for statistical purposes only and analysed independently by staff in the Northern Ireland Statistics and Research Agency (NISRA) in the strictest confidence. Thank you for your cooperation.

National Insurance number

Please enter your National Insurance Number below:

Gender

Please tick one box:

Male
Female

Age

Please give your date of birth:

Date
(DD) / Month
(MM) / Year
(YYYY)

Community Background

Please indicate your community background by ticking the appropriate box below:

I have a Roman Catholic community background
I have a Protestant community background
I have neither a Protestant or Roman Catholic community background

Disability

The Disability and Discrimination Act (DDA) defines a disability as a “physical or mental impairment which has substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities”. The Equality section in the Candidate Information booklet gives an explanation of this definition. Please read that section and then answer the question below.

Do you consider yourself to have a disability (Please tick one box below)

Yes
No

Race

Please tick one box to indicate your race:

White / Black African
Black Caribbean / Bangladeshi
Chinese / Black Other
Pakistani / Indian

Are you a member of a Mixed Ethnic Group?

Yes
No

Are you a member of the Irish Travelling Community?

Yes
No

If you are of other ethnic origin, please specify

Language

Is English your first language? (Please tick one box below):

Yes
No

Sexual Orientation

Please consider the statement below and tick one box:

My sexual orientation is towards someone:

Of the same sex (this covers gay men and lesbians)
Of a different sex (this covers heterosexual men and women)
Of the same sex and of the opposite sex (this covers bisexual men and women)

Marital status

Please indicate your marital status by ticking one box below:

Single, that is never married or in a civil partnership
Married
Separated, but still legally married
Divorced
Widowed
In a civil partnership
Separated, but still legally in a civil partnership
Formerly in a civil partnership which is now legally dissolved
Surviving partner from a civil partnership

Dependants