Independent Board Member Application Form Survey

Question Title

* 1. Your details

Name

Address

Address 2

City/Town

Postal Code

Email Address

Phone Number

Question Title

* 2. Are you related to a member of staff, former member of staff or board member of Northwards Housing?

Yes

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* 3. If you are employed, please tell us the name and address of your employer

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* 4. Why would you like to be a board member? Use this space to tell us about yourself.

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* 5. Contact details for referee 1

Name

Company

Address

Address 2

City/Town

Postal Code

Email Address

Phone Number

Question Title

* 6. Contact details for referee 2

Name

Company

Address

Address 2

City/Town

Postal Code

Email Address

Phone Number

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* 7. Have you been disqualified by a court from acting as a company director or been removed as trustee of a charity?

Yes

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* 8. Are you an undischarged bankrupt (except with leave of the court)?

Yes

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* 9. Has a court made an order against you for failing to make a payment you are required to make under an administration order for a person's estate?

Yes

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* 10. Are you currently admitted to hospital under the Mental Health Act 1983? Or has a court issued an order for your detention or appointed a receiver to look after your property because of mental illness?

Yes

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* 11. Have you any convictions, other than those which are "spent" under the Rehabilitation of Offenders Act 1974?

Yes

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* 12. Do you have rent arrears or other housing related debt of more than £100 and no satisfactory arrangement to pay?

Yes

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* 13. Are you a former tenant who did not end the tenancy according to the agreement?

Yes

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* 14. Are you a former tenant with a legal possession order against you?

Yes

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* 15. Have you been accused of behaviour which spoils(t) the peaceful enjoyment of residential dwellings, or have been violent to, or threatened your landlord's staff or agents?

Yes

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* 16. Have you an unspent conviction for a community offence or are you the subject of an Anti social behaviour order or other civil restraining order and are a significant risk to the community

Yes

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* 17. Do you live with a person in one of the categories mentioned in questions 7-16?

Yes

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* 18. Are you an employee of Manchester City Council or Northwards Housing? Or are you related to an employee or a Northwards board member?

Yes

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* 19. Have you ever been employed by Northwards Housing or Manchester City Council?

Yes

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* 20. Are you an elected councillor or are you related to any elected councillor?

Yes

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* 21. Are you a senior employee of a partner organisation of Northwards?

Yes

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* 22. Are there any other issues which may affect your suitability as a Northwards board member? For example, something which could be considered a conflict of interest?

Yes

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* 23. If you have answered yes to any of the above questions please give more information below

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* 24. Do you agree to completing a Disclosure and Barring Service check if your application is successful?

Yes

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* 25. By ticking this box, you confirm that the information you have submitted is complete and correct to the best of your knowledge and that, if elected, you agree to comply with all rules, policies and obligations of Northwards board members.

Agree

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* 26. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 27. Gender

Male

Female

I'd rather not say

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* 28. Ethnicity

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* 29. Religion or belief

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* 30. Sexual orientation

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* 31. Do you consider yourself to have a disability?

Yes

Prefer not to say

Independent Board Member Application Form

Question Title

* 1. Your details

Question Title

* 2. Are you related to a member of staff, former member of staff or board member of Northwards Housing?

Question Title

* 3. If you are employed, please tell us the name and address of your employer

Question Title

* 4. Why would you like to be a board member? Use this space to tell us about yourself.

Question Title

* 5. Contact details for referee 1

Question Title

* 6. Contact details for referee 2

Question Title

* 7. Have you been disqualified by a court from acting as a company director or been removed as trustee of a charity?

Question Title

* 8. Are you an undischarged bankrupt (except with leave of the court)?

Question Title

* 9. Has a court made an order against you for failing to make a payment you are required to make under an administration order for a person's estate?

Question Title

* 10. Are you currently admitted to hospital under the Mental Health Act 1983? Or has a court issued an order for your detention or appointed a receiver to look after your property because of mental illness?

Question Title

* 11. Have you any convictions, other than those which are "spent" under the Rehabilitation of Offenders Act 1974?

Question Title

* 12. Do you have rent arrears or other housing related debt of more than £100 and no satisfactory arrangement to pay?

Question Title

* 13. Are you a former tenant who did not end the tenancy according to the agreement?

Question Title

* 14. Are you a former tenant with a legal possession order against you?

Question Title

* 15. Have you been accused of behaviour which spoils(t) the peaceful enjoyment of residential dwellings, or have been violent to, or threatened your landlord's staff or agents?

Question Title

* 16. Have you an unspent conviction for a community offence or are you the subject of an Anti social behaviour order or other civil restraining order and are a significant risk to the community

Question Title

* 17. Do you live with a person in one of the categories mentioned in questions 7-16?

Question Title

* 18. Are you an employee of Manchester City Council or Northwards Housing? Or are you related to an employee or a Northwards board member?

Question Title

* 19. Have you ever been employed by Northwards Housing or Manchester City Council?

Question Title

* 20. Are you an elected councillor or are you related to any elected councillor?

Question Title

* 21. Are you a senior employee of a partner organisation of Northwards?

Question Title

* 22. Are there any other issues which may affect your suitability as a Northwards board member? For example, something which could be considered a conflict of interest?

Question Title

* 23. If you have answered yes to any of the above questions please give more information below

Question Title

* 24. Do you agree to completing a Disclosure and Barring Service check if your application is successful?

Question Title

* 25. By ticking this box, you confirm that the information you have submitted is complete and correct to the best of your knowledge and that, if elected, you agree to comply with all rules, policies and obligations of Northwards board members.

Question Title

* 26. Age

Question Title

* 27. Gender

Question Title

* 28. Ethnicity

Question Title

* 29. Religion or belief

Question Title

* 30. Sexual orientation

Question Title

* 31. Do you consider yourself to have a disability?

Question Title

* 32. Please tell us about any reasonable adjustments you may need during the interview or selection process