Orford, Warrington, WA2 9BX

Home-Start Warrington, The Smile Centre,

Orford, Warrington, WA2 9BX

Registered Charity Number 1116515

Company Number 5563277

Application Form to become a Trustee with

Home-Start Warrington

Name:
Address:
Home Phone:
Work Phone:
Mobile:
E-mail:
Date of Birth:
How long have you lived in the UK?
How did you hear about Home-Start Warrington?
Why are you interested in becoming a Trustee for Home-Start Warrington

What skills and experiences do you have that may be relevant to your work as a trustee for Home-Start Warrington? This may include paid employment, voluntary work, parenting/childcare, hobbies or interests.

The following areas of knowledge, skills and expertise are all valuable to a Trustee board. Please indicate any areas that you consider you can bring to this role:

Finance
Fundraising
Personnel Management
PR & Marketing
Health & Safety
Management
Other specialist skills
Children & young families
Networking
Voluntary sector
Diversity – working with minority ethnic communities or people with a disability etc

What specific areas of Home-Start’s work / the work of the Trustees interest you?

How much time could you offer to Home-Start Warrington on a regular basis? (Trustees would usually be expected to volunteer for approximately 10 hours per month)

Is there any condition in your health, mobility of accessibility that might affect your volunteering?

Yes / No

If yes, please give details, including any particular support or assistance that you would need to carry out the work as a Trustee.

References

Please give the names and addresses of two character referees (not relatives). Referees must have known you for at least two years.

Referee 1
Name:
Address:
Phone No:
Capacity in which they have known you:
Referee 2
Name:
Address:
Phone No:
Capacity in which they have known you:

I give permission for Home-Start Warrington to carry out a Disclosure & Barring Service check (DBS) for criminal convictions, or any other checks, with the Department of Health, Social Services or Department for Education as required. I understand that my National Insurance number may be required.

Data Protection Act 1998. The information given above will be used solely for the purpose which it was given, that is to assess your suitability to be a Home Start Warrington trustee, for communication within the organisation and monitoring purposes. It will be held confidentially, updated when appropriate and destroyed when no longer required.

I know of no reason why I would be unsuitable to become a Trustee.

Signed: / Date:

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Confidential