Fillable SCHOOL GOVERNOR APPLICATION FORM Appointment to a Governor (Rochdale Metropolitan Borough Council)

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SCHOOL GOVERNOR APPLICATION FORM Appointment to a Governor (Rochdale Metropolitan Borough Council)

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1
SCHOOL GOVERNOR APPLICATION FORM
Appointment to a Governor role is subject to Disclosure and Barring vetting check (DBS),
completion of rehabilitation of declaration form and provision of personal information.
Please return your completed application to SchoolGovernors@rochdale.gov.uk.
Please complete every section on the form in order to progress your application.
Please read the guidance notes including the grounds for disqualification from being a
governor before completing this form.
☐ I have read the grounds for disqualification from being a governor. I am not disqualified on any of
these grounds.
Section 1: About You
Title
Forename
Surname
Address 1
Address 2
Town
Postcode
Telephone no (Home)
Mobile
E-mail address
Occupation
Date of birth
Please outline the school governing boards, the area or the type of school for which you
are interested in serving as a governor (e.g. name of the school, primary schools in Heywood, or
any secondary schools)
2
Please specify any school governing boards that you DO NOT wish to serve as a governor
Have you previously served as a governor?
☐ Yes
☐ No
Please state the number of boards you are willing to serve as a governor on
Please provide us with any other information in support of your application
Section 2: Skills Set
Please indicate the knowledge/skills/experience you possess (TICK BOX), please note, you would
not be expected to hold all of these skills, this will be used to match your skills to the school
governor vacancies:
☐
Governance
☐
Finance
☐
HR e.g. policy/process, recruitment, dealing with complaints, HR issues and appeals
☐
ICT
☐
Health services
☐
Project management
☐
Strategic planning
☐
Appraisal/performance management
☐
Procurement/purchasing
☐
Property/estate management
☐
Safeguarding, including prevent
☐
SEND
3
☐
Community cohesion
☐
Experience of school sector risk management / health and safety
☐
Current education policy
☐
Inspection/oversight in school sector/ School improvement
☐
Experience of complying with legal, regulatory and financial frameworks and statutory guidance
☐
Self-evaluation
☐
Data analysis
☐
Decision making
☐
Experience of chairing a board/committee/meeting
☐
Leadership
☐
Change management
☐
Communication
Please provide us with any other relevant information in support of your application including
other knowledge, skills, experience, including any specialist knowledge you possess. Please
consider both paid and unpaid experience
Section 3: Declarations
I declare that I am not disqualified from serving as a school governor and that:
I am aged 18 or over at the date of this election or appointment;
I do not already hold a governorship of the same school;
I have not been detained under the Mental Health Act 1983;
I have not had my estate sequestrated (temporarily repossessed) and the sequestration has not
been discharged, annulled or reduced, or the subject of a bankruptcy restriction order, an interim
order, a debt relief restrictions order or an interim debt relief restrictions order;
I am not subject to
a disqualification order or undertaking under the Company Directors Disqualification Act
1986,
a disqualification order under Part 2 of the Companies (Northern Ireland) Order 2002,
a disqualification undertaking accepted under the Company Directors Disqualification
(Northern Ireland) Order 2002, or
order made under section 429(2)(b) of the Insolvency Act 1986 (failure to pay under
county court administration order).".
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 anybody;
I am not included in the list kept under section 1 of the Protection of Children Act 1999(list of those
considered by the Secretary of State as unsuitable to work with children);
I am not subject to a direction of the Secretary of State under section 142 of EA 2002 (or any other
4
disqualification, prohibition or restriction which takes effect as if contained in such a direction);
I am not barred from regulated activity relating to children in accordance with section 3(2) of the
Safeguarding Vulnerable Groups Act 2006;
I am not disqualified from working with children under sections 28, 29 or 29A of the Criminal
Justice and Court Services Act 2000
I am not disqualified from registration under Part 2 of the Children and Families (Wales) Measure
2010 for child minding or providing day care; or disqualified from registration under Part 3 of the
Childcare Act 2006.
I have not, in the five years prior to becoming a governor, received a sentence of imprisonment,
suspended or otherwise, for a period of not less than three months without the option of a fine;
I have not, in the twenty years prior to becoming a governor, been convicted as aforesaid of any
offence and has had passed on me a sentence of imprisonment for a period of not less than two
and a half years;
I have not, at any time, had passed on me a sentence of imprisonment for a period of not less than
five years;
I have not been fined, in the five years prior to becoming a governor, for causing a nuisance or
disturbance on education premises;
I am not subject to a disqualification order under the Criminal Justice and Court Services Act 2000.
The nature of the work for which you are applying means that you are exempt from Section 4 (2) of
the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.
You are not, therefore entitled to withhold information about any cautions or convictions which for other
purposes are “spent” under the provisions of the Act and, in the event of you being appointed to the post,
any failure to disclose such convictions could result in dismissal or disciplinary action by the Council.
It is a condition of your appointment as a school governor that you return this completed form to the
Governor Support Team. The information on the form will be considered and, if you have declared any
previous criminal convictions, these may be discussed with you prior to a decision being taken on your
appointment.
Please be aware that the Authority has a policy on the recruitment of ex-offenders and that a criminal
record will not automatically debar anyone from being a Governor with the School/Council.
Have you ever been cautioned or convicted of any offence in a Court of Law?
☐ Yes
☐ No
If you have answered yes to the above question please give brief details and dates of any offence/s:
DECLARATION
Please sign to declare that the above statements are an accurate correct and that you have provided
accurate information about your cautions and convictions. By signing this declaration you are confirming
that the information on the form is complete, true and accurate to the best of your knowledge and that you
are aware that providing false or misleading information will result in you being unable to continue as a
Governor.
Signed: Dated:
Please return your completed application to SchoolGovernors@rochdale.gov.uk
Find out how we use your personal information at rochdale.gov.uk/privacy.
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SCHOOL GOVERNOR APPLICATION FORM Appointment to a Governor (Rochdale Metropolitan Borough Council)

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Completed 10 December 2020

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