Non-Executive Director & Chair

Application form

Gloucestershire Airport

November 2017


Eligibility

Thank you for your interest in becoming a Non-Executive Director of Gloucestershire Airport.

We value the time you have already taken to read the Recruitment Pack.

However, some of you may not be eligible to undertake a Non-Executive Director role and we wanted to make this clear before you commit further time to completing the application form.

If you can answer ‘Yes’ to any of the following questions you will not be eligible to be a Non-Executive Director.

Do you have an unspent criminal conviction either under the Company Directors Disqualification Act 1986 or in accordance with the Rehabilitation of Offenders Act 1986? / Yes/No
Are you an undischarged bankrupt or do you have any arrangements with your creditors under the Company Directors Disqualification Act 1986? / Yes/No
Are you currently admitted to hospital under the Mental Health Act 1983, or as a result of mental illness subject to a court order for your detention or have a receiver appointed to look after your property? / Yes/No

Your application

Your completed application form must be received no later than 5pm on Friday 1st December 2017

Please email your completed form to

If you need assistance with filling out the application form, please contact HR Business Centre team (Publica Group Limited) on 01242 774930.

For any general enquiries about the role, please contact Mark Sheldon, Director, Cheltenham Borough Council on 01242 774951.


About you

Surname / Title
Forename(s)
Known as
Date of birth
Address
Postcode
Preferred contact telephone number
Alternative contact telephone number
Preferred email address

Career history (last 3 roles)

Company/organisation / Dates (from/to) / Position
Brief description of duties
Company/organisation / Dates (from/to) / Position
Brief description of duties
Company/organisation / Dates (from/to) / Position
Brief description of duties


Education and qualifications

Please list all academic and professional qualifications (including awarding body and relevant dates)

Your interest in becoming a Non-Executive Director

Please outline as specifically as possible why you would like to become a Non-Executive Director and how you consider that you meet the Non-Executive Director specification in the Recruitment Pack (in no more than 500 words)

Your interest in becoming Chair (if applicable)

Please outline as specifically as possible why you would like to become Chair and how you consider that you meet the specification in the Recruitment Pack (in no more than 500 words)

Please tell us about your skills and experience

Business Skills and Experience: performance monitoring; financial monitoring; risk management; strategic thinking; legal; compliance (in no more than 500 words)

Interpersonal Skills and Experience: leadership; relationship and people management; influencing and networking; communication (in no more than 500 words)

Life Skills and Experience: decision making; problem solving; creative thinking; assertiveness; resilience

(in no more than 500 words)

Anything else you would like to tell us

(Including any special requirements that you would need in order to join and participate fully in the Board)

Please tell us where you first heard about this role

It would be helpful for monitoring purposes if you could tell us where you first heard about this role.

Gloucestershire Airport website
Cheltenham Borough Council website
Gloucester City Council website
Guardian Jobs
CIPFA
Flight Global/International
Linked-In
Other (please specify)

Declaration

Are you a current elected member of a local authority or have you been a member within the last 4 years?
The expression “local authority” is defined in Section 67(3) of the Local Government and Housing Act 1989, which is attached in brief below.
SECTION 67(3) OF THE LOCAL GOVERNMENT AND HOUSING ACT 1989
“Any reference in this Part to a local authority is a reference to a body of one of the following descriptions a:-
1. Local authority (including a parish).
2. Fire, police or waste authority.
3. Joint authority of any of the above.
4. Number of other peripheral organisations. / Yes/No
Are you related to or do you have a personal connection with any Councillors or employees of the shareholding Councils or Airport? / Yes/No
Are you a trustee, an employee, advisor or, on the committee of any other charity, company or any other organisation or do you volunteer at any of these? / Yes/No
Have you ever been the subject of any investigation or proceedings by any regulatory body relating to your employment? / Yes/No
Have you ever been disqualified from practicing by any governing professional body? / Yes/No
Have you ever been dismissed from any employment, office or other position for reason of misconduct? / Yes/No
Are you aware of any conflict of interest that would arise should you be appointed as a Non-Executive Director? / Yes/No
Please provide details in the space below if you answer ‘Yes’ to any of the questions above.
The 1998 Data Protection Act controls the obtaining and use of data about individuals. The information provided by you as part of your application, together with any other personal information you provide or that is obtained e.g. references from former employers, will be retained for 3 months following the conclusion of the recruitment period. If you are successful with your application and subsequently take up a contract for services, this information will be retained for the duration of your contract and for at least 6 years afterwards. Your personal details will not be passed to any third party (except with regards to a reference request), without your consent. Your details will be used to assess your suitability and competence to hold a contract for services for the role of Non-Executive Director and for statistical analysis purposes. By signing this application you are giving consent for the obtaining and holding of personal data as described above.
If selected to be a Non-Executive Director, as part of checking that you are ‘fit and proper’ to hold the role, a search (through a Credit Reference Agency) will be made into your financial standing.
Please sign below to confirm your agreement to such information as referred to above being obtained and held and to declare that the information given in this application form is true, accurate and complete to the best of your knowledge and ability. This declaration may be taken as part of any subsequent contract for services and any false statement or withholding of any relevant information may result in the termination of appointment.
Signature……………………………………………………………………………… Date……………………………

References

Please give details of two referees, both of whom must be able to comment on your suitability as a Non-Executive Director Chair.

Can we contact your referees before interview? / Yes/No
Referee 1: / Referee 2:
Name: / Name:
Position: / Position:
Company name: / Company name:
Company address: / Company address:
Company postcode: / Company postcode:
Telephone: / Telephone:
Telephone (mobile): / Telephone (mobile):
Email address: / Email address:
In what capacity do you know this person? / In what capacity do you know this person?
Thank you for taking the time to complete this application.

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