Stakeholder Application Form

Skills & Experience
What made you apply to be a stakeholder? If you have applied for a condition-specific place, please also tell us why you want this place in particular (max. 3,000 characters).*

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Do you have any relevant experience including employment, voluntary work, community activities, etc. (There is an option to attach your CV below). If you have applied for a condition-specific place, please tell us about your experience working or volunteering formally or informally in that condition area (max. 3,000 characters).*

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What relevant skills and expertise would you bring to the board? If you have applied for a condition-specific place, please also talk about why your skills and expertise are relevant to this (max 3,000 characters)*

0/3000
Are you a stakeholder/trustee for any other company(s)?*

YesNo
If yes, please specify:
Do you have any other connections to The Disability Union and/or any other charities/ organisations operating in the Disability sector?*
If you would like to attach your CV, please do so here:

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References

Please provide us with two (2) references that are familiar to your work and/or social life, and who we may contact.

Ideally, one should be a work/ study/ volunteer/ activity-based reference, and the other may be a personal reference.
Reference 1
Name:*

First NameLast Name
Phone Number:*
Email Address:*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How is your first referee connected to you?*

Reference 2
Name:*

First NameLast Name
Phone Number:*
Email Address:*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How is your second referee connected to you?*
Please confirm that you consent to us contacting these referees:*

Yes, I consent to you contacting these refereesNo, I do not consent to you contacting these refereesOther

Is there anything else you would like us to know in relation to your application?
Declaration

I hereby certify that all the information given in this application form is true and accurate.

I hereby give my consent for the information provided in this application to be held on a computer or other relevant filing systems. Please note, your information will not be shared with any other organisations or third parties.

You may withdraw your consent at any time by contacting lauren.toovey@disabilityunion.co.uk.
Signature*

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Date*

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Date
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