Governor with digital experience - application form

Governor Application

Name(Required)

Address(Required)

Phone

Mobile(Required)

Email Address(Required)

Supporting Statement(Required)

CV Upload(Required)

Max. file size: 512 MB.

Have you ever been convicted of a criminal offence(Required)

All appropriate posts at St Richard’s Hospice are subject to DBS disclosure.

Yes

Please provide three professional references

Reference 1

Reference 1 – Name(Required)

Reference 1 – Address(Required)

Reference 1 – Phone number(Required)

Reference 1- Email(Required)

Reference 1 – Relationship to you(Required)

Reference 2

Reference 2 – Name(Required)

Reference 2 – Address(Required)

Reference 2 – Phone number(Required)

Reference 2 – Email(Required)

Reference 2 – Relationship to you(Required)

Reference 3

Reference 3 – Name(Required)

Reference 3 – Address(Required)

Street Address Address Line 2 City Postcode

Reference 3 – Phone number(Required)

Reference 3 – Email(Required)

Reference 3 – Relationship to you(Required)

Declarations

Automatic Disqualification Declaration(Required)

Charities must satisfy themselves that individuals who hold (or are applying for) a trustee position will not be disqualified from holding that position.

Please see the guidance here.

I declare that: I am not disqualified from acting as a trustee; and I will inform the trustees promptly if, after the date of this declaration, one or more of the disqualification reasons applies to me.

Use of your information(Required)

I confirm that I have read the Privacy notice and Terms and Conditions of St Richard’s Hospice and consent to the use of my personal data as set out as stated.

I confirm

Governor with digital experience – application form

Governor Application

Reference 1

Reference 2

Reference 3

Declarations