Seeking Trustees | Pie Factory Music

General Information

Name *

First

Last *

Last

Where did you see this post advertised? *

Home Address *

Home Address

First line of address

Second line of address

City

County

Postcode

Country

Home Phone Number

Mobile Phone Number

Email Address *

Motivation

Please explain why you would want to become a Trustee of Pie Factory Music: *

Do you have any previous Trustee or charity experience? *

Yes

No

If yes, please give details:

Details of past Trustee / Charity experience

Skills & Interests

Please give details of the skill areas you've selected above: *

Please include details of any other skills and interests that may be relevant to the role of Trustee. This can include languages spoken, creative skills, public duties, community or voluntary work experience:

Suitability & Conflicts of Interest

Are you aware of any matter, which might call into question your integrity as a trustee or bring you / or Pie Factory Music into disrepute? These may include criminal investigations or convictions, financial affairs and reputation? *

Yes

No

Are you aware of any matter, which may present a conflict of interest if you were to be elected as a Trustee? These may include personal relationships or membership of organisations? *

Yes

No

If the answer is yes to either of the above questions please give details here: *

Criminal Offences

Do you have any unspent cautions, convictions, police reprimands or warnings? *

Yes

No

If the answer is yes to the above question please give details here: *

Is there anything else you'd like to tell us?

Reference 1

Please give details of people who can comment on your suitability for this role. Please note that references from relatives are not acceptable.

Name *

First

Relationship to you *

Organisation and Position

Address *

Address

City

State/Province

Zip/Postal

Country

Email Address *

Phone Number

Reference 2

Please give details of people who can comment on your suitability for this role. Please note that references from relatives are not acceptable.

Name *

First

Relationship to you *

Organisation and Position

Address *

Address

City

State/Province

Zip/Postal

Country

Email Address *

Phone Number

Declaration

I confirm that the details given in this form are correct and understand that any false declaration may result in my removal from the Board of Trustees.

Yes

No

I confirm that: 1. I am aged 18 years or over at the date of this election or appointment 2. I do not have an unspent conviction relating to any offence involving deception or dishonesty 3. I am not an undischarged bankrupt (or subject to sequestration in Scotland) or have current composition or arrangement including an individual voluntary arrangement (IVA) with your creditors 4. I am not subject to a disqualification order under the Company Directors Disqualification Act 1988 or to an Order made under section 429(b) of the Insolvency Act 1986 5. I have not been removed from the office of charity trustee or trustee for a charity by an Order made by the Charity Commissions or the High Court on the grounds of any misconduct or mismanagement (or equivalent in other jurisdictions) 6. I am not disqualified from being a company director 7. I am not disqualified under the Protection of Vulnerable Adults List 8. I am not barred by the Disclosure and Barring Service (DBS) from work involving contact with children or vulnerable adults (regulated activity). 9. I will, if elected, undertake a Disclosure and Barring Service check 10. I have read the Charity Commission booklet CC3: The Essential Trustee – what you need to know https://www.gov.uk/government/publications/the-essential-trustee-what-you-need-to-know-cc3/the-essential-trustee-what-you-need-to-know-what-you-need-to-do 11. I understand and am able and willing to commit necessary time, preparation and effort to the proper discharge of the responsibilities of a trustee 12. I hereby explicitly consent to Pie Factory Music holding my personal details within a manual or electronic filing system in relation to the Data Protection Act 1998