Trustee Application Form

Trustee Application Form
Thank you for your offer to become a Trustee of Brent Foodbank. In order for us to process your application please would you answer the following questions:

(If you have any questions about your application or would like help completing it please contact Mr Lawrence Hanna, lawrence@brent.foodbank.org.uk)
Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation*
Qualifications*
Please outline your professional qualifications

Which of the following skills or experience can you bring to our board? Please indicate against each relevant area if this is your Principle skill, or a Secondary skill where you have experience.*

	Principal	Secondary
Human Resources
Financial/Accounting
Fundraising
Business Management
Marketing/PR
Welfare/Welfare Rights
Legal
Cultural
Children & Young People
Law
Health
Knowledge of the Community
Other*

*If Other, please specify:
Please indicate why you want to become a trustee of Brent Foodbank and how you think your own skills and experience would enable you to fulfil the role of a Trustee as described in the Role Description (300 words) *
Please give us any information you think may be useful to us:
I can confirm that I am available for the specified hours as mentioned on the role description -*

YesNo
Would you be willing to for us to submit for a DBS criminal record check, if required?*

YesNo
Trustee applicant’s declaration of eligibility:

I declare that:

·       I am over the age of 18.

·       I do not have an unspent conviction for one or more of the offences listed here

·       I do not have an IVA, debt relief order and/or a bankruptcy order

·       I have not been removed as a trustee in England, Scotland, Northern Ireland or Wales (by the Charity Commission or Office of the Scottish Charity Regulator or The Charity Commission for Northern Ireland)

·       I am not under a disqualification order under the Company Directors' Disqualification Act 1986.

·       I have not entered a composition or arrangement with creditors, or have an individual voluntary arrangement (IVA) and I am not on the Insolvency Service Register

·       I have not been disqualified by the Charity Commission nor have been found guilty of disobedience to an order or direction of the Charity Commission

·       I am not a disqualified company director

·       The information I have provided is true, complete and correct

·       I understand that it’s an offence under section 60(1)(b) of the Charities Act 2011 to knowingly or recklessly provide false or misleading information

·       I undertake to fulfil my responsibilities and duties as a trustee of Brent Foodbank in good faith and in accordance with the law and within Brent Foodbank’s objectives/mission and Code of Conduct for trustees.

·       I do not have any financial interests in conflict with those of Brent Foodbank (either in person or through family or business connections) except those that 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.
Data protection:

Brent Foodbank will hold your details on file but will not release them to a third party.

I confirm that the above information is complete and correct. I consent to the processing of this data in the consideration of my application and during the course of my trusteeship, if applicable.
Signature*

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Date*

DayMonthYear
Date
How did you hear about becoming a trustee at Brent Foodbank?
Registered Charity No: 1206072 | Registered in England & Wales
Brent Foodbank is committed to protecting data privacy and will process your personal data in accordance with current data legislation. Your data will only be used for purposes relating directly to your trustee activity. It will only be seen by foodbank personnel responsible for your trusteeship. It will not be sold or passed to any other organisation.
A full data privacy statement is available from the Foodbank on request.
Should be Empty:

Trustee Application Form

Thank you for your offer to become a Trustee of Brent Foodbank. In order for us to process your application please would you answer the following questions: