United Purpose Trustee Application Form

United Purpose

TRUSTEE APPLICATION FORM

& VOLUNTARY EQUAL OPPORTUNITIES MONITORING FORM

Thank you for your interest in United Purpose and for taking the time to fill out this application form.

Use the ‘tab’ key to move from one answer field to the next. Answer fields will expand to accommodate your answers. Please return the completed form to the address detailed in the ‘Application Process’ section appended to the Job Description.

Application Details
Date of application (dd/mm/yy):
How did you first learn about this vacancy? Please name the specific website or source.
When would you anticipate being able to take up the role of Trustee (dd/mm/yy)?

Why do you wish to become a Trustee of United Purpose?

Please explain what interests and motivates you about the opportunity to join the United Purpose Board and why you are suited to the role of a Trustee, why you are suited to the role of Trustee, and particularly to act as the organisation's Treasurer

Governance Role

Starting with the most recent, please provide details of Governance positons you have held, that you think are relevant to this application.
Your Skills
In the Skills/Experience Section, please rate yourself using a scale of High (3) to Low/Not Applicable (1) to reflect the level of experience possessed in a particular area.
Skills and Experience / Rating (1-3)
Belief in/Support of Mission
Board of Director Experience
CEO Succession Planning
Networks
Financial
Fundraising
Grant Writing
Human Resources
knowledge of the International Development Sector
Leadership
Legal
Lobbying
Marketing/PR
Organisational Management
Risk Management
Strategic Planning
Stakeholder Engagement
Sustainable Development
Project Management
Technology/IT
Please explain which threeof your key skill areas will best enable you to fulfil the role of a Trustee and why

Career Summary

Please provide a brief overview of your career and detail your current and previous role (or your last two previous roles if you are no longer working)

Professional Bodies and Qualifications

Please list membership of any professional bodies, and any professional qualifications you have gained (with dates)

Languages (Written & Spoken)

Mother tongue

Other Language(s)

/ Basic Knowledge / Working Knowledge / Fluent
Please list / Written / Spoken / Written / Spoken / Written / Spoken
1.
2.
3.
4.
5.

Additional Information

Please use this space to provide any further information in support of your application

References

Please give the names and contact details of two referees, one of whom should be your present employer (or last employer if you are no longer working.) We will not contact them without your prior consent.
Referee 1: / Referee 2:
Name: / Name:
Job Title: / Job Title:
Capacity in which they know you: / Capacity in which they know you:
Address: / Address:
Daytime Telephone Number: / Daytime Telephone Number:
Email Address: / Email Address:

Personal Details

Surname:

First Names:
Name you like to be called:
Address:
Tel. No. (Daytime):
Tel. No. (Evening):
Tel. No. (Mobile):
E-mail Address:
Do you hold a current driver’s licence (pls tick box): / Yes
No
Do you hold any unspent convictions?
(Tick as appropriate) / Yes
No
A conviction will not necessarily exclude you from employment with United Purpose, but will be taken into consideration when assessing your suitability for this particular position. Please refer to our Criminal Records Policy on our website for more details.

United Purpose is committed to short-listing candidates meeting selection criteria who have a disability or impairment. For this reason, if you are shortlisted and you consider yourself to have a disability or impairment that requires special arrangements, please let us know before the interview.

I confirm that to the best of my knowledge the information provided in this document is true and correct and can be treated as part of my contract of employment.

Name:

Date:

Receipt of every application will be acknowledged. However, you will then only hear from us if you are short-listed for interview. Short-listed candidates will be contacted within four weeks of the closing date.

United Purpose Equal Opportunities Monitoring Form (Voluntary)

United Purpose wholeheartedly supports the principle and application of equal opportunities in employment and the provision of service. We oppose all forms of discrimination on the grounds of sex, gender reassignment, race, religion or belief, ethnic or national origins, age, sexual orientation, disability, perceived or actual HIV status, or marriage and civil partnership. We support the principles stated in the Equality Act 2010. United Purpose believes that our vision of a world where justice, dignity and respect prevail for all requires that all the human resources, talents and skills available throughout the communities where we work are duly considered when employment opportunities arise.

This form is voluntary, but it is very helpful for us to ensure that we are successfully implementing our equal opportunities policy. We would be very grateful if you could complete this confidential form. It will not be sent to the recruiting panel and has no part in the shortlisting process, and will be stored separately.

Please return this form, along with your application, to

Your Ethnic origin
/ Asian, Asian British, Asian English, Asian Scottish, or Asian Welsh
Asian / Asian British
Bangladeshi
Chinese
Indian
Pakistani
Other Asian background (specify if you wish): / / White
British
English
Gypsy or Irish Traveller
Irish
Scottish
Welsh
Other White background (specify if you wish):
/ Black, Black British, Black English, Black Scottish, or Black Welsh
African
Caribbean
Other Black background (specify if you wish): / / Mixed
White and Asian
White and Black African
White and Black Caribbean
White and Chinese
Other mixed background (specify if you wish):
/ Other ethnic group
Arab
Other ethnic group (specify if you wish): / / Prefer not to say
Do you identify as: / Male
Female
Prefer not to say
Age
Disability: The Equality Act 2010 defines a disabled person as someone who has a physical or mental impairment which has a substantial and long-term adverse affect on their ability to carry out normal day-to-day activities. / Do you consider yourself to be disabled?
Yes.
Please specify:
No
Prefer not to say
Data protection: Information from this application may be processed for purposes registered by United Purpose under the Data Protection Act 1998. Individuals have, on written request [and on payment of a fee] the right of access to personal data held about them.
I hereby give my consent to United Purpose to process the data supplied in this form for the purpose of recruitment and selection.
Name: / Date: