** CONFIDENTIAL **

Application to serve as a director/trustee of AVP Britain

About you

Full name
Address
Postcode:
Phone no.
Email:
For Register of Directors:
Full date of birth:
Nationality: / Business occupation:
Any former forenames/surnames:

Awareness of responsibilities of Board Members

If your application is successful then we will also ask you to sign the AVP Volunteer Agreement Form, which sets out AVP Britain'scommitment to support you in your voluntary work with us.

Have you read the Terms of Reference for the AVPB Board of Trustees? / YES / NO
Have you read the Job Description for a Member of the Board of Trustees? / YES / NO
Are you aware of the commitments and obligations of being a Director/Trustee of a charitable company, and are you prepared to meet this commitment? / YES / NO

Interests, skills and experience

Please describe your interest in joining the AVPB Board.
What relevant skills and experience do you have?
Do you have any relevant training or qualifications?

Employment history(please include voluntary positions if relevant)

Please briefly describe your three most recent jobs, beginning with your current or most recent role.

Role:
Organisation:
Start and end dates (years):
Brief description of work:

Continued over...

Role:
Organisation:
Start and end dates (years):
Brief description of work:
Role:
Organisation:
Start and end dates (years):
Brief description of work:

Referees

Please provide details of two referees, of which one should be an employer.

Name, position, organisation
Relationship to you
Address
Phone: / Email:

Continued over...

Name, position, organisation:
Relationship to you
Address
Phone: / Email:
How did you hear about this opportunity

Declaration

'I declare that all information given above is correct and I understand that if any relevant information is subsequently found to be misleading or inaccurate this could cause sufficient grounds for withdrawing any offer made or agreement entered into.'

Signed...... Date......

Please note that this form requires a hand-written signature; for legal reasons digital versions cannot be accepted.

Thank you very much for your interest in supporting the Alternatives to Violence Project in this way.

Please return this form to Chair of the Board of Trustees at the address on the first page. If you have any queries please call the office on 020 7324 4755.

______

AVP, September 2012

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