Trustee Application Form MCMC Trustee Application Form How did you hear about this vacancy at My Cancer My Choices? * FacebookInstagramLinkedInWebsiteWord of MouthNewsletter Title * Name * Name First Name First Name Last Name Last Name Your Email Address * Your Phone Number * No symbols and no spaces Your Date of Birth * Your Home or Private Address Your Home or Private Address * Address 2 Town /City * Town/ City County * County Postcode * Postcode Your Address for Correspondence (if different from above) Your Address for Correspondence (if different from above) Address 2 Town /City Town/ City County County Postcode Postcode Career History Please include all relevant paid and unpaid work, including non-executive appointments if applicable, starting with the most recent. Name and Address of Organisation * Date Started Current Position * Yes No Date Ended I do not recall the dates of this position If you do not recall the dates of this position, what is/was the approximate length you were in this position? Post, Title(s) and brief details of responsibilities, academic or professional qualifications obtained * plus1 Add minus1 Remove Career History In addition, to your employment or voluntary work history, please give details of any Public, Charity or Third Sector appointments held in the past 8 years, starting with the current or most recent Organisation & Position Appointed by Time Commitment Date Started Current Appointment Yes No Date Ended I do not recall the dates of this role If you do not recall the dates of this position, what is/was the approximate period you were in this position? plus1 Add minus1 Remove Brief statement of academic or professional qualifications and / or membership of professional bodies, or training received that you feel is particularly relevant to the role of Trustee in this sector. * Basis of Interest Please indicate what level of expertise, knowledge or experience you have in the following areas. * None Some Substantial Charity governance and charity law * None Some Substantial Legal * None Some Substantial Audit experience * None Some Substantial Voluntary/third sector experience * None Some Substantial Medical/ Health professional * None Some Substantial Leadership experience * None Some Substantial Enterprise skills/Business development and strategy * None Some Substantial Change management * None Some Substantial Listening skills * None Some Substantial Conflict resolution * None Some Substantial Facilitating meetings * None Some Substantial Customer care experience * None Some Substantial Partnership working – multi agency, including statutory, community and charity * None Some Substantial Relationship Management * None Some Substantial Government policy and the implications for a charity such as My Cancer My Choices * None Some Substantial Financial management and strategy * None Some Substantial Human Resources –policy and practice * None Some Substantial Recruitment * None Some Substantial Training and development * None Some Substantial People Management * None Some Substantial Project Management * None Some Substantial Property/Facilities Management * None Some Substantial Marketing, PR and communications skills * None Some Substantial Campaigning * None Some Substantial Quality Standards * None Some Substantial IT/systems * None Some Substantial Digital strategy * None Some Substantial Social Media * None Some Substantial Experience in Complementary Therapies * None Some Substantial Fundraising knowledge, skills and contacts * None Some Substantial Corporate Social Responsibility * None Some Substantial Grant applications * None Some Substantial Administrative experience e.g. minute taking * None Some Substantial Board/Committee experience * None Some Substantial Income generation * None Some Substantial Influencing/networking * None Some Substantial Service user/beneficiary of the organisation * None Some Substantial Mentoring/coaching * None Some Substantial Research * None Some Substantial Business analysis * None Some Substantial Personal Attributes Why do you want to become a Trustee for My Cancer My Choices? * Please describe the key attributes that you would bring to the role of trustee. * Connections to My Cancer My Choices Are you related to any employee or Trustee of MCMC? If YES, please give their name, role. * Have you been personally introduced to the work of MCMC or the possibility of becoming a trustee? If so, please indicate who introduced you. * References Please supply the names, addresses and telephone numbers of two referees. They should be people who know you well and can speak from personal experience of how you meet the requirements of the role and competencies of a Trustee. Please tell us in what capacity they know you. Name * Name First Name First Name Last Name Last Name Address * Address 2 Town /City * Town/ City County * County Postcode * Postcode Phone * No symbols or spaces Email * In what capacity does this person know you * plus1 Add minus1 Remove Data Protection Statement The information that you provide on this form and that obtained from other relevant sources will be used to process your application. The personal information that you give us will be used in a confidential manner to help us monitor our recruitment process. If you succeed in your application and take up the position, the information will be used in the administration of your role with us. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process. We may check the information collected with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing the application form we will be assuming that you agree to the processing of sensitive personal data (as described above) in accordance with our registration with the Data Protection Commissioner. Agreement & Acknowledgements * I am over 18 years of age I am not an undischarged bankrupt I have not previously been removed from trusteeship of a charity by a court or the Charity Commission I am not under a disqualification order under the Company Directors' Disqualification Act 1986 I have not been convicted of an offence involving deception or dishonesty (unless conviction is spent) I am, in light of the above, not disqualified by the Charities Act 1993 (section 72) from acting as a charity trustee I do not have any financial interests in conflict with those of MCMC (either in person or through family or business connections) except those which I have formally notified in a conflict of interest statement. I will specifically notify any such interest at any meeting where trustees are required to make a decision which affects my personal interests and I will absent myself entirely from any decision on the matter and not vote on it By submitting this form you agree to our Privacy Policy. If you are human, leave this field blank. Next
