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D e n n i s

ACADEMY TRUST

  • building a team for competition

PRIVATE AND CONFIDENTIAL

DENNIS-ACADEMY TRUST APPLICATION FORM

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Please note: This application should be completed, signed and dated and then returned to Dennis Academy Trust. Please write only within the text boxes. If needed, continue on a separate sheet of paper and attach it to this document.

 

References may be contacted if applications are successful.

 

On appointment as a Trustee a Disclosure and Barring Service (DBS) check will be undertaken.

Title:

First Name:

Surname:

Please tell us how you became aware of this vacancy:

Please return the completed application form to the CEO Head office Email: ceo@dennis-academy.com

Post: FAO Dennis-Academy Trust, 4 bethune road london n16 5bd

 

 

Dennis Academy Trust Trustee Application Form Page 1 of 6

Title:

 

Forename(s):

 

Surname:

 

Former name:

 

Date of birth:

 

Address:

 

Email address:

 

Telephone (home):

 

Telephone (work):

 

Telephone (mobile):

 

Present job title:

 

Present employer:

 

Male

 

Female

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Dennis Academy Trust Trustee Application Form Page 2 of 6

Dennis Academy Trust Trustee Application Form Page 3 of 6

Personal details

                                                                                                       

Please explain why you are interested in the role of Trustee at Dennis-Academy Trust and provide an overview of the skills and expertise you would bring to the Trust Board.

Are you currently, or have you been, a Trustee or a Governor at another establishment?

Yes No

If ‘yes’ please provide details:

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Have you ever been removed from membership of a Governing Body or Board of Directors for any reason?

Yes No If ‘yes’ please provide details of the establishment and the reason for your removal:

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Do you have any criminal convictions? If ‘yes’ please provide details:

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Yes No

Is there anything in your personal or professional life that may bring Dennis Academy Trust into disrepute?

If so please provide details:

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Are you, or have you been:

A parent or carer of a child in a WAT academy? If ‘yes’ please provide details:

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An employee of a WAT academy?

Yes No

If ‘yes’ please provide details:

A contractor or supplier to a WAT academy? If ‘yes’ please provide details:

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Dennis Academy Trust Trustee Application Form Page 4 of 6

Dennis Academy Trust Trustee Application Form Page 5 of 6

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References

Please provide the details of two referees, please note these people cannot be related to you, your spouse or civil partner.

 

 

Reference One:

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Name:

 

Address:

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Email address:

 

Telephone:

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Capacity in which they know you:

 

 

 

 

 

Reference Two:

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Name:

 

Address:

 

 

Email address:

 

Telephone:

 

Capacity in which they know you:

 

 

Declaration of Eligibility to Become a WAT Trustee

Please answer 'yes' or 'no' to following questions:

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I am aged 18 or over.

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I do not already hold governorship at one of WAT’s academies.

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I am not liable to be detained under the Mental Health Act 1983.

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I am not a bankrupt or subject to a disqualification order under the Company Directors Disqualification Act 1986 or to an order made under section 429(2)(b) of the Insolvency Act 1986.

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I have not been removed from the office of a Charity Trustee or Trustee for a charity by an order made by the Charity Commissioners or the High court on the grounds of any misconduct or mismanagement or, under section 7 of the Law Reform (Miscellaneous provisions) (Scotland) Act 1990, from being concerned in the management or control of any body.

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I am not included on the barred list the list of teachers and workers with children or young persons whose employment is prohibited or restricted.

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I am not disqualified from being the proprietor of any independent school or from being a teacher or other employee in a school.

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I have not, in the five years prior to applying to be a Trustee, received a sentence of imprisonment, suspended or otherwise, for a minimum of three months without the option of a fine.

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I have not, in the twenty years prior to applying to be a Trustee, been previously convicted of any offence and had passed on me a sentence of imprisonment for a minimum of two and a half years.

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I have not, at any time, had passed on me a sentence of imprisonment for a minimum of five years.

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I have not, in the five years prior to applying to become a Trustee, been fined for causing a nuisance or disturbance on education premises.

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I am not subject to a disqualification order under the Criminal Justice and Court Services Act 2000. My estate has not been sequestrated.

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I am not the subject of a bankruptcy restrictions order or an interim order.

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Signed:

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Print:

 

Date:

                                                                                                Dennis Academy Trust Trustee Application Form Page 6 of 6

Contact

I'm always looking for new and exciting opportunities. Let's connect.

ceo@dennis-academy.com

07405567556

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