Mind in Haringey trustee application form

Name
Home Address / Post Code
Telephone / Home / Mobile
Work
E-mail
Occupation
Qualifications
Which of the following skills or experience could you bring to the Board? / Please indicate against each relevant area whether it is your Principle skill, by writing ‘P’, or a secondary skill where you have experience, by writing ‘S’.
P/S / P/S
Housing / Business Management
Financial / Accounting / Marketing / P.R.
Fund Raising / Human Resources
Legal / Management in a voluntary organisation

The Person Specification outlines some of the key skills we seek in a potential Trustee for Mind in Haringey. Please indicate against each of the following broad categories how you think your own skills and experience would enable you to fulfill the role of a Trustee as described in the Role Description. You may also want to enclose a CV with this application.

Key skills / Narrative
  1. Commitment to principles of Mind in Haringey

  1. Interpersonal

  1. Teamwork

  1. Communication

  1. Drive and determination

  1. Strategic perspective

  1. Intellectual and technical ability

  1. Leadership

  1. Experience

  1. Circumstances

  1. Equal
Opportunities
As a Mind affiliated association, we are committed to participation in the agency by people who use or who have used mental health services. In this connection, we would appreciate it if you could say whether
or not you have ever been a user of mental health services, and whether you have ever thought of
Yourself as in mental distress?
Why do you wish to become a Trustee of a Mind in Haringey
What does user involvement mean to you?

Please give details of two people who would be willing to provide a reference.

Name / Name
Address
Post Code / Address
Post Code
Tel / Tel
Email: / Email:

Please sign and return this form to:

Mind in Haringey, 73c Stapleton Hall Road, LondonN4 3QF

Signature Date

Equal Opportunities monitoring

As an equal opportunities employer, it would assist us with our monitoring process to know your ethnic background.

Please tell us which background you identify with by ticking next to each category.

Asian
African
African-Caribbean
Black European
Black UK
Chinese
Greek
Greek Cypriot
Jewish
Middle Eastern
Turkish
Turkish Cypriot
White European
White UK
Other (please state)

Do you consider yourself to have a physical disability?

YesNo

Do you consider yourself to have a disability / impairment covered by the Disability Discrimination Act 1995?

Please delete as appropriate: Yes/No

The Disability Discrimination Act (DDA) defines a disabled person as someone who has a physical or mental impairment that has substantial and long term adverse effect on his/her ability to carry out normal day-to-day activities which has lasted or is likely to last for at least 12 months

Is there anything we need to know in order to offer you a fair selection process at interview? If yes please give details:

Should you be successful in your appointment, please can you state below any specific arrangements that we would need to make in order to accommodate you?