Lay and Registrant Council Member Application Form (ref: GOC16/04)

This application form is available in alternative formats (for example, braille, audio or large print). Please submit your request to the Governance team ().

There are 10 sections to complete in this application form, please ensure you have completed them all. Deadline: Monday28 November 2016 (12.00pm noon)

SECTION ONE: PERSONAL DETAILS
Title:
Surname:
Forename(s):
Full home address (with postcode) :
Email address:
Telephone number (home):
Telephone number (mobile):
Where did you learn about the vacancy?
Please confirm if you are lay or a GOC registrant? / Lay GOC registrant
GOC registrant no. (if applicable)
SECTION TWO: RELEVANT EXPERIENCE
Please attach a brief, up-to-date Curriculum Vitae (CV) (no more than 3 sides A4) as a separate document to your application. Your CV should outline: your experience, including relevant employment history; any relevant voluntary work, public service or other experience; and any relevant professional, academic or vocational qualifications. NB: CVs alone will not be accepted. Your CV will be used to assist the assessment of your expertise.
Current (or most recent) relevant position held and date of appointment:
SECTION THREE: ESSENTIAL CRITERIA
Please indicate how you meet the essential criteria detailed in the person specification. It is important that you use examples which are based upon real situations, clarify the task you had to achieve, outline the action you took and identify the result of your action(s). If necessary, you may use the same evidence or example against more than one criterion.
3A. Please give evidence of your strategic awareness and ability to contribute to strategic direction.Please use no more than 300 words.
3B. Please give evidence of your ability to be held accountable and to hold others to account.Please use no more than 300 words.
3C. Please give evidence of your capacity and skill to understand the functions of the GOC, priorities of GOC stakeholders and ability to inspire confidence amongst key GOC stakeholders.Please use no more than 300 words.
3D. Please give evidence of your ability to listen, communicate and influence effectively.Please use no more than 300 words.
3E. Please give evidence of your ability to build effective relationships and work effectively as part of a teamPlease use no more than 300 words.
3F. Please give evidence of your demonstrable commitment to equality, diversity and inclusion – dealing with people and issues honestly, fairly and with respect.Please use no more than 300 words.
3G. Please give evidence of your analytical capacity, intellectual flexibility and sound judgement. Please use no more than 300 words.
SECTION FOUR: DESIRABLE CRITERIA
Please indicate how you meet the desirable criteria detailed in the person specification. It is important that you use examples which are based upon real situations, clarify the task you had to achieve, outline the action you took and identify the result of your action(s). If necessary, you may use the same evidence or example against more than one criterion.
4A.Please give evidence of your understanding of professional regulation in either the public or private sectors and its impact on service delivery, education and professional development.Please use no more than 300 words.
4B. Please give evidence of your experience of delivering governance in the public and private sector, understanding the boundaries between executive and non-executive responsibilities. Please use no more than 300 words.
4C.Please give evidence of your knowledge and experience of corporate performance management.Please use no more than 300 words.
Please note it is also desirablefor candidates to indicate that they meet one or more of the following criteria in order to strengthen the skills, knowledge and understanding on Council. It is important that you use examples which are based upon real situations, clarify the task you had to achieve, outline the action you took and identify the result of your action(s). If necessary, you may use the same evidence or example against more than one criterion.
4D.Please give evidence of yourknowledge and experience of financial work in a complex organisation, responsible for leading teams and managing budgets/resources; preferably with a financial qualification.Please use no more than 300 words.
4E. Please give evidence of your knowledge and experience of risk management and/or audit work in a complex organisation. Please use no more than 300 words.
4F. Please give evidence of your knowledge and experience of higher education, learning and development.Please use no more than 300 words.
4G. Please give evidence of your specialist expertise relating to the work of the GOC in a field such as: legal, performance management, human resources, fitness to practise, contracts and procurement, communications and/or service delivery. Please use no more than 300 words.
4H.Please give evidence of your knowledge of technology as a driver/facilitator of transformational change.Please use no more than 300 words.
SECTION FIVE: REFERENCES
Please give details of two professional referees who you consider are best placed to support your application.
  • “Professional referees” refer to individuals who have observed you acting in a productive capacity where you have displayed the skills/knowledge relevant to the role in question. Examples include former/current employers, colleagues, supervisors or professors.
  • The GOC will not accept personal references, for example from family members or friends.
  • The GOC will not accept references from GOC employees.
  • The GOC can accept references from GOC Council, Committee, Education Visitor Panel or Hearings Panel members who are not involved in the selection process provided they know you outside of their role at the GOC.
References will be asked for all shortlisted candidates as soon as the candidate is invited to interview. An appointment will not be recommended until we have received two satisfactory references.
REFEREE 1 / REFEREE 2
Name: / Name:
Relationship to you: / Relationship to you:
Organisation: / Organisation:
Telephone number: / Telephone number:
Email address: / Email address:
SECTION SIX: DISQUALIFICATION CRITERIA
In accordance with the requirements stated in the information pack, you are required to confirm that none of the disqualification criteria set out in Annex A of the information pack apply to you.
Can you confirm none of the disqualification criteria set out in Annex A of the information packapplies to you? / Yes No
SECTION SEVEN: CONFLICTS OF INTEREST
Please read the section on management of interests in the candidate pack carefully (section 5 of the candidate pack).
Do you have any business or personal interests that might be relevant to the work of the GOC and which could lead to a real or perceived conflict of interests were you to be appointed? / Yes No
If Yes please give details:
Do you have any close personal relationships with other GOC members or employees that may be perceived as a conflict of interest? / Yes No
If Yes please give details:
SECTION EIGHT: ENSURING PUBLIC CONFIDENCE
Should you be successful in your application, is there anything about your professional or personal history which, if brought into the public domain, may cause embarrassment or disrepute to the GOC. / Yes No
If Yes please give details:
SECTION NINE: INTERVIEW AVAILABILITY
Are you available to attend an interview on the published interview date(s) (as specified in section three of the candidate pack)?
Please note that on the occasion you cannot attend the interview date published, the Selection Panel may consider a new date, but at their discretion and in light of those interviewed first time. / Yes No
SECTION TEN: DECLARATION
I declare that the foregoing information is correct to the best of my knowledge and belief and I have included all material facts which may have a bearing on my application. / I agree that the General Optical Council may use the information provided in this application for monitoring purposes.
We will treat all your data in accordance with the Data Protection Act 1998
Signed:
If emailing, type name. / Yes No
Date:

Thank you for taking the time to complete this application form.

Please return the application form, a copy of your CV (maximum 3 A4 pages), and any monitoring forms by email to: .To ensure our IT systems can open your application safely, please send in Microsoft Word or PDF format.

Once you have submitted your application, we will acknowledge safe receipt within two working days.

Page 1 of 6