APPLICATION FORM – TRUSTEE - CONFIDENTIAL

Please complete in block capitals
Full Name
Address
including Post Code
Home Tel. No.: / Mobile No.:
Date of Birth: / Place of Birth:
Nationality: / Ethnic Origin:
E-mail address:
Family Details
Which post are you applying for? e.g Trustee, Chairperson, Treasurer / How did you hear about Home-Start?
Management Committee Meetings – would times present any difficulty? / YES / NO
Why are you interested in becoming a Home-Start Trustee?
Please give details of any voluntary or paid work you have done, particularly with children and families:
Have you any commitments that could affect you giving time to Home-Start Perth e.g. part time work?
Have you any skills or personal experiences that may be relevant to the role of either Chairperson or Treasurer or are you interested in any specific areas of Home-Start’s work?
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 people with disabilities, minority ethnic communities etc
Is there any condition in your health, mobility or accessibility that may affect your volunteering?
Yes No
If yes, please give details, including any particular support or assistance that you would require.
REFERENCES: Please give the name and address of two referees (not a relative) who may be contacted by Home-Start Perth
Referee 1 / Referee 2
Name:
Address:
Capacity in which they know you: / Name:
Address:
Capacity in which they know you:

As Trustees may have contact with young children, Home-Start Perth has a responsibility to ensure that no one becomes a Trustee who would misuse this trust. Therefore, it is essential that you complete and sign this form.

Name:
Have you had any personal contact with Social Services/Social Work Department or NSPCC/Children 1st in connection with children in your care? / YES / NO
Do you have any medical condition (physical or mental) that could affect your work as a volunteer? / YES / NO
Have you ever been dismissed from any paid or voluntary work? / YES / NO
Have you ever been arrested or dealt with by the police for any type of criminal offence? / YES / NO
Are there any matters outstanding that may lead to a criminal prosecution? / YES / NO
If you answer yes to any question please give details:
If you do not declare existing or spent cautions or convictions you may not be selected. However, if you declare any of the above it may still be possible to become a Trustee.

I give permission for Home-Start Perth to contact my nominated referees and I understand that I will be required to join the Protection of Vulnerable Groups (PVG) scheme for a criminal records check through Disclosure Scotland. I understand that my National Insurance number may be required for identification purposes.

I know of no reason why I would be unsuitable to be a Home-Start Trustee.

I understand that Home-Start may hold personal information about me in records and on their computer, including sensitive information such as age, race, sex and disabilities that they will use for monitoring purposes. I agree to them holding this information and understand that it may be shared with Home-Start UK for Quality Assurance purposes.

I understand that I may ask to see my records at any time.

Home-Start Perth operates a policy for the recruitment of ex offenders and a copy of this is available from the Office on request.

Signed: / Date:

Scottish Charity Number : SC000986

Company Limited by Guarantee Registered in Scotland No 268665