Trustee Application Form

Personal Information

Title

First Name

*

Last Name

*

Date of birth

*

Address Line 1

*

Address Line 2

*

Town

*

City

*

Post Code

*

Home Telephone

*

Work Telephone

*

Mobile Number

*

Please tick if we can contact you at work

Email

*

Preferred method of contact

*

Reference 1

Name

*

Address Line 1

*

Address Line 2

*

Town

*

City

*

Post Code

*

Daytime Telephone

*

Mobile Number

Relationship

*

How long have they know you?

*

Reference 2

Name

*

Address Line 1

*

Address Line 2

*

Town

*

City

*

Post Code

*

Daytime Telephone

*

Mobile Number

Relationship

How long have they known you?

Employment History

Upload file here

Please give a summary of all employment in reverse order, including any relevant unpaid (voluntary) work. You may attach your CV if you wish

Skills and Experience

Why are you interested in becoming a trustee of Mosaic Clubhouse?

*

Do you have experience of working with any other voluntary organisations? If yes, please give detail

*

In what areas do you have skills, experience or knowledge? (please select all relevant boxes) *

Fundraising
Legal
Marketing/PR
Knowledge of the Local Community
Working With BME Community
Finance
Health and Safety
Risk Management
Human Resources
Mental Health
Change Management
Property
Private Sector
Public Sector
Education
Stategic Planning
Voluntry Sector
Other

Please give details of how much time you could make available to us

conflict of interest

Please give details of any business or other interests, which might give, rise to conflict of interest, and how you would address the issues should you be successful in your application

File Upload

Please download and fill in this declaration form , to be uploaded to at the bottom of this form.

When uploading documents please ensure total file size is under 10mb