Application Form
Board Members

APPLICATION FORM FOR BOARD MEMBERSHIP

Your Details
Full Name
Postal Address
Telephone No.
Email address
Experience and Qualifications
Please give below details of any current or previous experience that you feel is relevant to this application. This could include details of any voluntary work or paid employment, it could also include details of any qualifications or training.
Voluntary or paid work experience
Qualifications or training

HOMES BOARD MEMBER KNOWLEDGE, EXPERIENCE & SKILLS

In recruiting Board members of overriding importance will be the values, behaviours and personal approach. These will be assessed in a separate values assessment.

Below are the knowledge, experience and skills that are essential for the Homes Board to operate effectively.

Knowledge, Experience & Skills: Individual self-evaluation

Pleased indicate on the skills matrix below using the scale from expert to limited knowledge to indicate what you will bring to the Board in the following key areas:

·  Expert: You have specialist, up to date knowledge and experience in this area through work experience and/or qualification.

·  Proficient: You are confident in this area and would understand the details contained within board papers, being able to challenge, contribute and evaluate reports with an appreciation of implications of board decisions.

·  Working knowledge: You understand the basics of the subject and while you may not be able to contribute significantly or provide challenge, you will be able to evaluate options and appreciate the implications of board decisions.

·  Limited/None: You know little or nothing about this area and would require further training, development and briefing.

Your Skills
Please tick the boxes below which best describes the level of your knowledge that you feel you could bring to the Board.
Skills Matrix / Expert / Proficient / Working Knowledge / Limited/None /
Sustainability & Eco/Green Agenda
Equality & Diversity
HR & OD
Marketing & Communication
Social Profit
External/political environment & impact forecasting (National and Local)
Housing & Neighbourhood Management
Housing Maintenance Services
Development & Physical Regeneration
Community & Social Regeneration & Investment
Customer Service
Risk Management
Working with Local Authorities/Partners
Care & Support
Asset & Property Management
Performance, Efficiency & Improvement
Commercial, business planning and financial management skills
Funding & Treasury Management
Corporate governance, compliance & best practice
Project Appraisal Management and Financial Modelling
Planning & Delivering Change
Legal
Objective/Collective Decision Making

Personal Qualities

·  Passion for our cause

·  Willingness to commit time for board meetings, training sessions and special events

·  Team player – works well in a group

·  Someone who listens well- is thoughtful in considering issues

·  Empathy with our customers and their needs

Calico Values and Behaviours

About you
Please tell us briefly why you wish to become a Calico Homes Board Member.
Declarations
There are certain people who cannot be, or might not be suitable to be Group Board Members. Please place your signature against each one of the following declarations and provide extra information where requested.
Declaration / Signature
I am not bankrupt and I have not made a voluntary arrangement with creditors.
Bankruptcy searches will be carried out for all applicants
I have not been the subject of a custodial sentence imposed by a court in the United Kingdom in respect of any criminal act or omission, neither have I been convicted for any criminal act or omission for which a non custodial sentence has been imposed.
If you have declared that you have been convicted of a serious criminal offence please give details on a separate sheet. The terms of the Rehabilitation of Offenders Act 1974 may apply to this application. Please ensure that you are aware of the consequences of failure to comply with the Act. If you are in any doubt you should seek legal advice or speak to the Citizens Advice Bureau.
I am not disqualified under Part 3 of the Representation of the People Act or Audit Commission Act 1998.
I am not disqualified by the Department of Trade and Industry from being a company director.
I have/have not (delete as appropriate) been a director of a company which has gone into insolvent liquidation.
If you have declared that you have been a director of a company which has gone into insolvent liquidation, please give details on a separate sheet
I am not disqualified under Section 72 of the Charities Act 1993 from being a charity trustee
No order has been made in respect of me under the Mental Health Act 1983, neither am I incapable of acting by reason of mental disorder for which I am admitted to hospital under the Mental Health Act 1983.
Declaration (Con’t) / Signature
I am/am not (delete as appropriate) a tenant who is in current serious breach of my tenancy.
If you have declared that you are a tenant who is in serious breach of your tenancy please give details on a separate sheet.
I am not employed by Calico Group.
I have not got legal action for anti-social behaviour against me or someone living with me.

Please read the following statements carefully and if you wish to proceed sign and date this Application Form:

·  I have read and understood the details included with this Application Form;

·  If appointed I am prepared to comply with any relevant rules and obligations and to act in good faith and in the interests of Group Board;

·  I understand that if the Board reasonably believes that the behaviour of one of its Members is such to bring the Board or Committee into disrepute action may be taken to remove/exclude that person from the Board;

·  I know that Board Members are volunteers and are not entitled to receive payment (other than properly incurred expenses);

·  I declare that all the information provided on this Application Form is correct and that if appointed I will be liable to action which could include my removal from the Board and/or criminal action should I knowingly give false information;

·  I acknowledge that Calico Group will conduct any searches and checks necessary to verify this information. I understand that if I don’t want these checks to go ahead my application will not be progressed.

Signature______Date:______

Please return your completed Application Form to:

Email:

7 | Page