Application Form

THE DARTINGTON HALL TRUSTBOARD OF TRUSTEES

Please return this form to:
Chris Moores, Company Secretary, The Dartington Hall Trust, Higher CloseMain Building,
Dartington Hall, Totnes TQ9 6EP
or

Where did you see this role advertised?:
This information will help us to monitor the effectiveness of where we advertise vacancies.

We welcome applications in any format: Application form, CV, covering letter, video, etc.

Please ensure your application is accompanied by pages 1 and 4 of this form.

PERSONAL DETAILS(Required information)
Title:
Last Name:
First Name(s):
Address:
Postcode:
Preferred Daytime contact No:
Home Telephone No:
Mobile No (if different from above)
Email address:
Preferred method of contact (please X all that apply) / Email: / Phone: / Post:
Pages 2 and 3 of the form are optional and intended as a guide to help stimulate ideas for inclusion and not constrain individual creativity and expression. We are happy to accept any other form of application and suggest that the key components within these questions are addressed within that application.

WHY ARE YOU INTERESTED IN AND EXCITED BY THE ROLE OF TRUSTEE AT DARTINGTON?

Please continue on separate sheets as necessary.

WHAT DO YOU THINKYOU CAN BRING TO THE TRUSTEE BOARD AND TO DARTINGTON?

Please continue on separate sheets of paper as necessary.
REFERENCES (Required information)
Please give details of two people to whom we may apply for a reference.
Please note that your references would only be taken up in the event of you being shortlisted.
Referee 1 / Referee 2
Name: / Name:
Address: / Address:
Telephone No.: / Telephone No.:
Email Address: / Email Address:
Relationship: / Relationship:
Please tick if you do not wish us to contact this referee until we have obtained your authorisation / Please tick if you do not wish us to contact this referee until we have obtained your authorisation
DECLARATIONS (Required Information) Please delete as appropriate
Eligibility
I am over 18 years of age and know of no reasons that exclude me from being a Trustee or Company Director in the UK. / YES/NO
Rehabilitation of Offenders Act 1974
Do you have any convictions not spent under this Act? / YES/NO
Are you related to any Trustee or member of staff of The Dartington Hall Trust? / YES/NO
If yes, please give details
The information contained within this form will be held and processed in a computerised or manual filing system in line with the provisions of the Data Protection Act 1998.
I declare that all information provided in this form is correct and I understand that if appointed, there will be a need to undertake further eligibility checks.
If you are submitting this form electronically, in the absence of your signature the e-mailing of this form constitutes your personal certification that the details in this form are correct.
Signed: / Date:

Equal Opportunities Monitoring

Dartington is working hard to be an Equal Opportunities organisation, including at Board level. The information provided on this sheet will help us to monitor how effectively we are working towards this goal.

This information will be treated in the strictest confidence and be used for monitoring purposes only. It will not be used to inform any part of the selection process.

ETHNIC ORIGIN: / I would describe my race or cultural origin as / Please tick
White / British
Irish
Any other white background*
Mixed / White and Black Caribbean
White and Black African
White and Asian
Any other mixed background*
Asian or Asian British / Indian
Pakistani
Bangladeshi
Chinese
Any other Asian Background*
Black or Black British / Caribbean
African
Any other African background*
Other ethnic group / Other*
* If you have ticked any of the boxes marked other please give details:
I would prefer not to say
GENDER: / Male / Female / Other
.
AGE RANGE: / 18-25 / 45-55 / 75+
25-35 / 55-65
35-45 / 65-75
I do not wish to disclose my age at this stage
.(Please note that your date of birth will be required in the event of appointment)
DISABILITY STATEMENT
The Equality Act 2010 defines a disabled person as someone with a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.
Do you consider yourself to have such a disability? / YES/NO
If you are comfortable with doing so, please provide details:
Is there any information we should take into account to enable us to give you a fair selection interview?
If yes, please give details: / YES/NO

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Trustee Application March 2016