Nomination Form for the Appointment of a new Foundation Governor/Director If you are a governor applying for another term of office at the same school, do not complete this form but complete a ‘Renewing Governor Nomination Form’ available from https://schools.cliftondiocese.com/governance If you are a Priest/Deacon in the Clifton Diocese do not complete this form but complete a ‘Clergy Nomination Form’ available from https://schools.cliftondiocese.com/governance Personal DetailsTitle *Surname *Forename(s) *Any Previous Names Address *Postcode *Email *Home Phone Mobile Phone Are you currently employed? *YesNoOccupation Employment Details Please note that to consider your application, this form may be shared with the school(s) you are being considered for and/or with the Catholic educational trust that the school may be part of (if applicable), so that they may contact you. If appointed, to the school or any other school, your name, address, telephone number(s) and email address may be shared with the school, the Catholic educational trust that the school may be part of (if applicable), and the Governors Services Team of the relevant Local Authority (if appropriate) so they may contact you about training and any other governor matter. Other InformationHave you ever been or are you currently a school governor? *YesNoIf yes, please give details, i.e. name of school(s), period of office (give dates), type of governor, e.g. parent/foundation/LA/staff. What Diocesan/Local Authority governor training did you undertake? Diocesan Training (please give dates). Local Authority Training (please give dates). To ensure that all our schools' governing bodies are effective, it is the Bishop’s expectation that all governors/directors attend appropriate governor training provided by the Diocese and/or a Local Authority.Have you ever been employed at a school? *YesNoIf yes, please give details of the school, position held and dates. DisabilitiesDo you have any disabilities which will require special provision? *YesNoIf yes, please indicate the provisions which may be required so that we can strive to meet them. Personal StatementPlease indicate what skills you feel you can bring to a governing body by listing any of the following that apply below. Finance/Budgets, Buildings/Maintenance, Personnel, recruitment, Employment Law, Parish work, Educational Community work, Safeguarding, Parenting, Health & Safety, Analyse data, Problem solving, Take on new concepts and knowledge and develop new skills, Literacy (English), Numeracy for basic data, Commitment and willingness to learn.Please list them here Please list below the school(s) you are interested in serving and give your reasons. Please note:(a) Bishop Declan may decide not to make an appointment, if he considered that to do so would result in the school’s governing body having an undue number of Foundation Governors who are also eligible to be Parent and/or Staff Governors;(b) the diocese is not able to guarantee that you will be appointed to serve on the school of preference, or at all.School Name Location Reasons School Name Location Reasons Do you have a child or a relation currently attending a Catholic school? *YesNoIf Yes, which school(s) and when do they leave? Are you related to a member of the staff or a governor at a Catholic school? *YesNoIf yes, please give the name of the relative and details of the school(s). ChurchChurch where you worship (name and location) *Can you confirm that you: (a) are a baptised Catholic (or have been received into the Catholic Church)? *YesNo(b) practise your faith? *YesNoPlease give any additional information you wish to provide in relation to your responses above. Questions relating to statutory disqualificationAge Verification Please tick this box to indicate that you are aged over 18NB: If you answer ‘Yes’ to any of the following you must provide full details enclosing any relevant documents. Are you a registered pupil at a school within the diocese? *YesNoAre you subject to a bankruptcy restrictions order or an interim bankruptcy restrictions order? *YesNoHave you had your estate sequestrated and the sequestration order has not been discharged, annulled or reduced? *YesNoHave you ever been disqualified from the office of governor for failure to attend governing body meetings for a continuous period of 6 months or more? *YesNoAre you subject to: i) A disqualification order or disqualification undertaking under the Company Directors Disqualification Act 1986? *YesNoii) A disqualification order under the Company Directors Disqualification (Northern Ireland) Order 2002? *YesNoiii) A disqualification undertaking accepted under the Company Directors Disqualification (Northern Ireland) Order 2002? *YesNoiv) An order made under Section 429(2)(b) of the Insolvency Act 1986 (failure to pay under County Court administration order)? *YesNoHave you ever been removed from the office of trustee for a charity on grounds of any misconduct or mismanagement in the administration of the charity for which you were responsible? *YesNoAre you included on the list of people considered by the Secretary of State as unsuitable to work with children? *YesNoAre you subject to a direction of the Secretary of State under s.142 of the Education Act 2002, s128 of the Education and Adoption Act 2006 or any other disqualification, prohibition or restriction [from working with children]? *YesNoAre you barred from regulated activity relating to children in accordance with s.3(2) of the Safeguarding Vulnerable Groups Act 2006? *YesNoAre you disqualified from working with children under ss28, 29 or 29A of the Criminal Justice and Court Services Act 2000? *YesNoAre you disqualified from registration under Part 2 of the Children and Families (Wales) Measure 2010 or child minding or providing day care? *YesNoAre you disqualified from registration under Part 3 of the Childcare Act 2006? *YesNoHave you received a sentence of imprisonment (whether suspended or not), in the UK or elsewhere, for a period of not less than three months (without the option of a fine) in the five years before becoming a governor or since becoming a governor? *YesNoHave you received a prison sentence of two and a half years or more in the 20 years before becoming a governor? *YesNoHave you at any time received a prison sentence of five years or more? *YesNoHave you been fined for causing a nuisance or disturbance on school and/or educational premises during the five years prior to or since appointment or election as a governor? *YesNo Declaration (please read, sign and date) I wish to offer my services to the Diocese of Clifton in the ministry of foundation governor/director. If I am appointed as a foundation governor/director I will undertake to seek to: * preserve and develop the Catholic character of the school(s)/college(s) to which I am appointed * ensure the school is conducted in accordance with its By Laws and/or Articles of Association, which includes the provisions of: a) Canon law b) The Curriculum Directory and Bishops’ statements on religious education and c) Any Bishop/Diocesan directives relating to schools/colleges * govern the school in accordance with its Instrument of Government/By Laws/Articles of Association, as appropriate, and in particular its ethos statement * become familiar with, support and implement the policies and procedures of the diocese, including the Bishop’s policies on education, including religious education, and to present those policies to the governing body * consider not only the interest of the individual school, but the interests of other Catholic schools and colleges and of Catholic education throughout the diocese * respond to the needs of the Catholic community as a whole as represented by the Bishop * attend the Diocesan training on appointment and any other relevant training required to support me in my role as a foundation governor * in all actions serve as a witness to the Catholic faith. I give my consent, in accordance with the UK GDPR and the Data Protection Act 2018, for the information contained in this form to be processed and stored for the purposes of recruitment. I agree to tender my resignation as a foundation governor/director if my circumstances change so as to contravene the diocesan expectations at any time during the tenure of office or if, in the opinion of the Bishop, my resignation would be in the best interests of Catholic education in the diocese. I understand that I may not start my appointment until the Bishop has received confirmation of a satisfactory enhanced Disclosure & Barring Service certificate and that a check will be required as part of the recruitment process. Details of the Disclosure will be recorded and retained indefinitely on the National CSAS Confidential Database. I understand that the appointment of foundation governors/director is at the absolute discretion of the Diocesan Bishop. Because of the nature of the decision-making process, Bishop Declan is unable to engage in any discussion or correspondence with the applicant or any other person(s) including Parish Priests and schools, where the application does not result in appointment.Electronic Signature By ticking this box, I indicate that I agree to the information in this Nomination Form for the Appointment of a new Foundation Governor/Director.I agree that I have given true information in this formFull Name *Date * Please consider whether you are legally entitled to volunteer before applying for this role. For EU nationals, you will have the right to volunteer legally if you have: settled or pre-settled status; European Temporary leave to remain; or a visa which does not prevent you from volunteering. For non-EU nationals, you will have the right to volunteer legally if you have a visa which does not prevent you from volunteering. If you are unsure whether your immigration status permits you to volunteer, please contact the UK Borders and Immigration Agency. Equal Opportunities:The Diocese of Clifton welcomes nominations from all members of the Catholic community, irrespective of race, colour, gender, age or disability. Information provided on this form, together with all other personal data held about these individuals by the Parish and the Clifton Diocese, is processed in accordance with the Diocese’s Privacy Notice; which is available at https://cliftondiocese.com/privacy-notice or from the Parish Office. RefereesPlease provide details of a Catholic Priest or Deacon who can verify your Catholic practice: Referee 1 Name *Address *Postcode Telephone Email Please provide details of two other referees who can verify your skills and suitability for the role. These must not be a relative, a member of staff or a governor from the school(s) to which you are applying: Referee 2 Name *Address *Postcode Telephone Email Referee 3 Name *Address *Postcode Telephone Email When you have submitted this form please complete and submit the DBS Self-Declaration Form available from: https://schools.cliftondiocese.com/governance VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
