* 1. Personal Details

* 2. How did you find out about this opportunity?

* 3. Please indicate your current employment status

* 4. Please explain your interest in cancer research and your reasons for wanting to work with the NCRI and the particular Clinical Studies Group that you have indicated. (300 words max)

* 5. Having read the enclosed background information and role description please describe below, giving examples, how you believe that your skills and experiences would enable you to meet the role requirements listed, in order to enable you to fulfil this role. (300 words max.)

* 6. What would you hope to achieve as NCRI consumer member, if you were appointed to this role? (100 words max)

* 7. Having read the role description, please describe any training needs you may have that would support you in this role.

* 8. Please indicate which NCRI Clinical Studies Group you are most interested in joining (select all that apply)

* 9. Please give the name and contact details of two people, and the capacity in which they know you, that you are happy for us to contact. Preferably, someone who has known/worked with you in the past two years and is able to comment on your ability to undertake the role:

* 10. Do you have any access needs we should be aware of to ensure you can take part in the recruitment process?

* 11. Would you like to be contacted should other opportunities for patient and carer involvement arise in the future?

* 12. Do you wish to have your details passed onto the NCRI Partners, who are engaging with consumers as appropriate (e.g. National Institute for Health Research and Cancer Research UK)

* 13. Any unspent criminal convictions will not necessarily exclude you from employment with Cancer Research UK, but will be taken into consideration when assessing your suitability for this particular position.

Do you hold any unspent criminal convictions or have any pending court cases?

* 14. Declaration

I agree to this information being used for legitimate purposes connected with recruitment and selection monitoring.

I declare that the information given is, to the best of my knowledge, true and complete.

If you email your application form you do not need to sign it now, but you will be asked to sign it should you be invited to join an NCRI Clinical Studies Group

* 15. Dates and availability
Dates and availability. Interviews for this role are planned to take place over the first 2 weeks of December, 2016. The next consumer training event will be on Wednesday 8th and Thursday 9th March, 2017, and the upcoming Consumer Forum Meeting is provisionally scheduled for Monday 13th February, 2017. It would be ideal if the successful applicant will be available for both of these dates. Please indicate availability.