TRUSTEE APPLICATION FORM

Please complete the form below.

We take safeguarding very seriously, so we do ask you to complete a full application form and provide evidence of identity.

This information will be used solely for the purpose of arranging and delivering activities with 21 Together. If you would like to be a subscriber and receive all our updates on services and activities then please become a SUBSCRIBER (you can subscribe in the footer of every page).

Which role are you applying for?

Are happy for your information to be held in the volunteer database for any future opportunities.

Your information will be kept for this reason only and you can request to be removed from the database at any time by emailing info@21together.org.uk

YES

Name

First Name

Last Name

Phone Number

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth

YYYY

Why would you like to take on the role of Trustee

Additional information can be emailed to info@21together.org.uk direct if you would like to add more information to any question.

What is it that particularly interests you in 21 Together as a charity, compared to other charities.

Please state your relevant experience and what you feel you would bring to the role.

Please list any relevant previous employment and/or voluntary experience with the dates you completed these.

If you prefer to send a CV please do this via email. info@21together.org.uk. If you applied through another platform and submitted your CV please just let us know here. No need to duplicate information.

REFERENCES

Please give two references, this may/may not be taken up at any point during the application process..

Name of reference one

Current / Most recent work / study area if possible.

First Name

Last Name

Reference one relationship to you

Email to contact reference

Name of reference two

If this a personal reference it must be a professional person such as teacher, soliciter, health professional or similar.

First Name

Last Name

Reference two relationship to you

Email to contact reference two

DBS information

Please choose the most relevant option

I do not agree to undergo any additional, necessary DBS checks.

I agree to undergo any additional, necessary DBS checks.

Do you have any convictions, cautions, reprimands or final warnings which are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?

YES

If you have answered yes, you now have two options on how to disclose your criminal record. Option 1: Please provide details of your criminal record in the space below. Option 2: You can disclose your record under a separate cover provided that you mark a cross on the line below and attach the details in an envelope stapled to this form. The envelope should be marked CONFIDENTIAL and state your name and the details of the post.

I am eligible to be a trustee

Please see https://www.gov.uk/guidance/automatic-disqualification-rules-for-charity-trustees-and-charity-senior-positions for further information about who is disqualified from being a trustee.

YES

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