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Candidate Application Form
Federation of Disability Sport Wales National Youth Forum
CandidateName:
Address:
Email address:
Preferred Contact Telephone Number:
Preferred method of contact: / ☐ / Voice call to telephone
☐ / Text to mobile number
☐ / Type Talk
☐ / In writing
☐ / Via a parent/guardian (please provide contact details)
Are you aged 18 or over? Yes _ No _
If you are over 18 there is no need to complete this section.
If you have answered No, we will require consent from your legal guardian before you can join a Youth Forum. Please could you fill in the information below
Name of GuardianRelationship
Email Address
Phone Number
Signature
Please could your guardian sign in the box provided to confirm they are happy for you to apply for the role on the DSW National Youth Forum.
Signature / DateWhich local authority are you currently from within Wales? Please Tick your local authority (✓)
Anglesey Powys
Gwynedd Rhondda Cynon Taff
Conwy Torfaen
Denbighshire Vale of Glamorgan
Flintshire Carmarthenshire
Wrexham Ceredigion
Blaenau Gwent Neath and Port Talbot
Bridgend Pembrokeshire
Caerphilly Swansea
Cardiff
Merthyr Tydfi
Monmouthshire
Newport
How did you hear about the national forum? Please Tick your local authority (✓)
Web _ Social Media _ Your Local DSW Officer _ Other Forum Group _ Word of Mouth _ Other ______
Application Form:
DSW National Youth Forum
1. Why do you want to be part of the DSW National Youth Forum?
2. We want to get to know you as forum members, tell us about yourselves. What are your hobbies, are you in school, collage or university, do you have any achievements you’d like to share whether it’s in sport, education or the workplace?
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3. Talk about any experiences, qualifications and skills you have developed over time, whether it’s coaching, volunteering or being around different disabilities and disability sport?
4. The Youth Forum is an opportunity for young people’s voices to be heard. What do you think you could bring to the DSW National Youth Forum?
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5. If there is one thing you could change in Wales to help people with a disability take part in sport as a participant, volunteer, official or in any other capacity, what would you change and why?
Please make sure you fill in the DSW Equal Opportunities Form at the bottom of the document
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If you have a question or query on any aspect of the application form or would like to give a verbal application please contact Darren Wyn Jones (Youth Forum Co-ordinator, Disability Sport Wales) on:
Mobile: 07557554272 (phone or text)
Email: please also copy
Completed Candidate Application Forms to be returned by:
9th December 2016
Return by post to: FDSW, Sport Wales National Centre, Sophia Gardens, Cardiff CF11 9SW
By email to: and
It is the sender's responsibility to ensure that documents actually reach their destination by the closing date and their receipt is acknowledged.
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Please ensure you have enclosed the following documents in your application:
· Completed Candidate Application Form
· Completed Equality Monitoring Form (to ensure that we achieve a balance of Youth Forum Members from a range of communities we would appreciate you complete this form – please note – this information WILL NOT be removed from the candidate application form
There will be circumstance in which the late arrival of Candidate Application Forms will be considered. If you are interested in applying but will not be able to meet the deadline, please contact Darren Jones (contact details as above) as soon as possible.
Disability Sport Wales is an equal opportunities employer and is committed to ensuring that no job applicant, employee, volunteer or member receives less favourable treatment on the grounds of age, gender, disability, race, ethnic origin, nationality, colour, parental or marital status, pregnancy, religious belief, class or social background, sexual preference, gender identity or political belief.15
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DSW Equal Opportunities Form
General information
In order to ensure that Disability Sport Wales achieve a balanced and diverse Board which is representative of a wide range of communities in Wales, it would be extremely useful if you would complete this form as openly as possible. Where applications are for Board Members, this form will be kept with the application form, and destroyed after short-listing or interview.
1. Are you related to, or a close friend of, any member or officer of Disability Sport Wales?☐ / Yes / ☐ / No
If yes, please state the name, relationship and, if applicable, the department in which he/she is employed
Name: …………………………………………………….. Relationship: …………………………………………………………..
Position: ………………………………………………….
2. Have you ever been convicted as a result of criminal proceedings?
☐ / Yes / ☐ / No
If yes, please give details of the offence, including the date and sentence:
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
You are not required to give any information on ‘spent’ convections under the rehabilitation of offenders act 1974 unless the post is exempt. Failure to disclose convictions could result in disciplinary action or dismissal
3. Which age group do you belong to?
☐ / 16 – 17☐ / 18 – 21
☐ / 22 - 24
4. My national identity is
(Select all that are relevant):
☐ / British / ☐ / Scottish / ☐ / English☐ / Welsh / ☐ / Northern Irish / ☐ / Irish
☐ / Prefer not to say
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4. What is your ethnic group?
Choose one section (A - E, or 'prefer not to say'), then tick one box to best describe your ethnic group or background.
A. White
☐ / Welsh/English/Scottish/Northern Irish/British / ☐ / Gypsy or Irish Traveller☐ / Irish / ☐ / Any other White background (please identify):
………………………………………………………………………..
B. Mixed/Multiple ethnic group
☐ / White and Black Caribbean / ☐ / White and Asian☐ / White and Black African / ☐ / Any other Mixed/multiple ethnic background (please identify):
………………………………………………………………………..
C. Asian/Asian British
☐ / Indian / ☐ / Bangladeshi☐ / Pakistani / ☐ / Chinese
☐ / Any other Asian background (please identify): / ………………………………………………..……………………………..
D. Black/African/Caribbean/Black British
☐ / African / ☐ / Caribbean☐ / Any other Black/African/Caribbean background (please identify): / ……………..…………………………………..
E. Other ethnic group
☐ / Arab / ☐ / Any other ethnic background (please identify):………………………………………………………………………..
☐ / Prefer not to say
5. Are you?
☐ / Male / ☐ / Female / ☐ / Prefer not to say6. Is your gender identity different to the sex you were assumed to be at birth?
☐ / Yes / If yes, please describe the difference: / ………………………………………………………………☐ / No / ………………………………………………………………
☐ / Prefer not to say
8. Have you ever identified as transgender or a trans person?
☐ / Yes / ☐ / No / ☐ / Prefer not to say15
9. How would you describe your sexual orientation?
☐ / Heterosexual/straight / ☐ / Gay man / ☐ / Prefer not to say☐ / Gay woman/Lesbian / ☐ / Bisexual
☐ / Other (please write in your preferred description): / ……………………………………………………………………….
10. Do you consider yourself to have an impairment?
o / Yes (go to 10.a) / o / No (go to 11) / o / Prefer not to say (go to 11)10.a How would you describe your impairment(s)?
Please mark all the boxes that apply to you☐ / Blind or Partially Sighted / ☐ / Deaf or Hard or Hearing / ☐ / Physical impairment (do not use a wheelchair)
☐ / Physical impairment (permanent wheelchair user) / ☐ / Physical impairment (use a wheelchair occasionally, or for sport) / ☐ / Learning disability (e.g. Downs Syndrome, etc)
☐ / Learning difficulty
(e.g. Movement Co-ordination Difficulty (Dyspraxia), Dyslexia, etc) / ☐ / Mental Health Condition
(e.g. depression, stress, etc) / ☐ / Long-term illness (e.g. cancer, multiple sclerosis, HIV+, etc)
☐ / Other (please specify): ………………………………………………………………. / ☐ / Prefer not to say
11. Which is your preferred language?
☐ / English (spoken) / ☐ / Welsh (spoken) / ☐ / Other European Language (spoken)☐ / Makaton / ☐ / British Sign Language
☐ / Prefer not to say
☐ / Other (please identify):
12. How do you use Welsh in day-to-day activities? (please select all that are relevant)
☐ / Speak / ☐ / Write / ☐ / Read☐ / Understand spoken Welsh / ☐ / No at all / ☐ / Prefer not to say
13. What is your religion or belief?
☐ / No Religion/Undecided / ☐ / Hindu / ☐ / Sikh☐ / Christian (including Church or England, Catholic, Protestant and all other Christian denominations) / ☐ / Jewish / ☐ / Spiritual
☐ / Buddhist / ☐ / Muslim / ☐ / Any other religion (please identify):
☐ / Prefer not to say / …………………………………………….
Is there anything DSW might need to know or put in place to ensure that you are appropriately supported within your role?
☐ / Yes / ☐ / No
If yes, please give further information:
……………………………………………………………………………………………………………………………………………………….……………
……………………………………………………………………………………………………………………………………………………….……………
……………………………………………………………………………………………………………………………………………………….……………
……………………………………………………………………………………………………………………………………………………….……………
Media Analysis
To assist with our recruitment process, please indicate where you first learned of this vacancy:
☐ / Newspaper / ☐ / DSW Website / ☐ / Other Website (please identify): ………………………………………………..☐ / Welsh Sports Association / ☐ / Word of Mouth / ☐ / Job centre
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