National Pensioners Convention Election 2015

National Pensioners Convention election 2015

Nomination form

Can I stand?

If you have joined the RCN NPC Network you might like to consider standing for one of the seats on the NPC National Council.

The working definition the RCN has agreed with the NPC for membership of the NPC is of a nurse or health practitioner “over 55 and in receipt of a pension”.

Term of office

The terms of office will be from 1 January 2016 to 31 December 2017.

When are the elections?

Opening of nominations / Monday 3 August 2015
Close of nominations / Monday 5 October 2015
Publication of candidates’ details on website / Wednesday 12 October 2015
Dispatch of voting papers via email or by post from independent scrutineer,Electoral Reform Services / Monday 26 October 2015
Close of voting / Friday 27 November 2015
Announcement of results / Tuesday 1 December 2015

Equal opportunities

The RCN is committed to supporting equality and diversity. If you need help with completing this form or would prefer it in a different format, please email telephone 020 7647 3640.
Nomination form

To submit your nomination please complete the form below and email it to

Alternatively you can send it to:

NPC election

Jane Clarke, Returning Officer

Room 209, Royal College of Nursing

20 Cavendish Square

London W1G 0RN

We will acknowledge all nominations by email within seven days of receipt. If you do not receive an acknowledgement, please contact us at

All forms must be received no later than 4.30pm on Monday 5 October 2015.

Please note all fields marked *are mandatory.

Part one: your details

Title* ______

First name(s)* ______

Last name* ______

Address* ______

______

Post code* ______

RCN membership number* ______

Year of joining the RCN* ______

Contact no* ______

Email address* ______

Part two: election statement*

Please include with this form a statement that in no more than 250 words demonstrates how your qualities and experience will help you fulfil your role on the National Pensioners Convention National Council.

You may type this below or submit it as a separate document with your nomination form.

Part three: professional career and RCN involvement*

Please summarise your career history, your involvement in the RCN and any other relevant experience – please expand the tables below if necessary.

Professional career

Dates (years) / Position / Main achievements

RCN involvement

Dates (years) / Position / Main achievements

Other relevant experience

Part four: where did you hear about this opportunity?

Please mark all those relevant:

Activate magazine / RCN email
Bulletin magazine / RCN website
RCN event or conference / RCN member
Facebook / RCN staff member
Twitter / RCN regional comms
Other (please explain):

Part five: equality and diversity*

The NPC is looking to broaden its membership and has asked us to ensure that at least two of the four RCN members on the NPC National Council are women and at least two are from minority groups.

Please tick the boxes below which apply to you.

I am*:

Male Female Transgender

Sexual orientation*:

Heterosexual Gay Lesbian Bisexual

Ethnic group*:

a) White / b)Mixed
English
Scottish / White and Black Caribbean
White and Black African
Welsh
Irish
Other White / White and Asian
Other Mixed
c)Asian or Asian British / d)Black or Black British
Indian / Caribbean
Pakistani / African
Bangladeshi / Other Black
Other Asian
e)Chinese or Chinese British
f)Other ethnic group (please specify)
g)Do you consider yourself to have a disability?*
Yes / No

Acceptance and declaration*

In signing thisform Iaccept the nomination and declare that:

a)I am over the age of 55 and in receipt of a pension

b)I am a member of the RCN NPC Network

c)I am able and willing, if elected, to fulfil the role and commitments as set out in the role description and to adhere to all RCN policies.

Signature: ______

Date: ______

To submit your nomination, please complete the form and email it to