AVH App Tenant Board Member by HC121001201225

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									              Tenant and Leaseholder Board Member Application Form

Please fill in the following details:

I am a secure tenant / leaseholder *delete as applicable

Your name:                       _____________________________________________

Your address:                    _____________________________________________

                                 _____________________________________________

Postcode:                        _____________________________________________

Telephone number(s):             _____________________________________________

Email address (if applicable):           ________________________________________


Further information
Do you hold any positions of public responsibility* (current or former):

…………………………………………………………………………………………….

………………………………………………………………………………………………….

Do you have any financial or business interest which may cause, or may appear to
cause, a conflict of interest with Aire Valley Homes or Leeds City Council?

                                               YES / NO
If yes, please give details: ………………………………………………………………….

………………………………………………………………………………………………….

Are you a member of a political party?**                                           YES / NO

Do you or have you worked for a political party?**                                 YES / NO

Are you related to any tenant, Councillor or Employee of Aire Valley Homes?**
                                                                    YES / NO
If yes, please give details: ………………………………………………………………….

………………………………………………………………………………………………….

* For example in local government, parliamentary activities or for other public bodies, including
voluntary groups / activities.
** This information will be held on the register of Board member interests


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PERSONAL STATEMENT

In order to help us know a little more about you, we are asking each candidate to
write a personal statement. If you would like some help with this please contact the
Involvement and Improvement Team on 0113 214 1798 or email
avhleeds.cit@avhleeds.org.uk

For guidance, please refer to the ‘person specification’. You may also wish to
include:

   Why you would like to be a Board Member?
   What you think you can offer in terms of your skills and experience?
   If you have been involved in any community activities and if you have any special
    interests?




Please attach an additional page(s) if you would like to tell us more.




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PEOPLE WHO CANNOT BE BOARD MEMBERS

Aire Valley Homes is a registered company and must comply with its ‘Memorandum
of Association’. This document is the companies constitution and governs the
company’s internal workings. It also prescribes who is eligible to become a Tenant
or Leasehold Board Member.

People who come under any of the following categories are not allowed to become
Board members of a company:

   Someone who is or becomes bankrupt or who makes a voluntary arrangement
    with creditors;
   Someone who is, or may be suffering a mental health disorder and;
          o is admitted to hospital under the Mental Health Act 1983; or
          o has a court order made for their detention or to appoint someone to
            look after their property or other affairs;
   Someone who is subject to a court order disqualifying him or her from serving as
    a Board Member of a company or who is otherwise prevented legally from being
    a company director.
   Leaseholder applicants who no longer live in their leasehold home.
If you are in any doubt, you should seek advice from us or your local Citizens Advice
Bureau.

Do any of the statements above, apply to you?
                                                                     YES/NO
If so please provide details:

………………………………………………………………………………………………….

………………………………………………………………………………………………….

Board Members are not paid wages, but reasonable expenses can be claimed for
travel costs, parking charges, carer and childcare costs. Reasonable expenses can
be claimed whenever the member is on official Board business.

Public funds must be protected, so the information you have provided on this form
may be used to prevent and detect fraud. The information may also be shared, for
the same purposes, with other organisations which handle public funds.

I confirm that, to the best of my knowledge, the information provided on this form is
true and correct.

Signed: ………………………………………………..

Date: …………………………………


Print name: …………………………………………..……………………………………


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Equal Opportunities

This part of the form is confidential and will be retained for monitoring purposes only.

We will be using information we may currently hold about you (like your age) to
monitor that applicants expressing an interesting reflect the wider diversity of
tenants. However, all applicants will be recruited on the basis of their ability and the
requirements of the role.

So that we can easily communicate with you please tell us if you have any
communication needs e.g. like a hearing or visual impairment?

We will try to make reasonable adjustments to accommodate your needs wherever
practical.

Communication needs?




If you have difficulty with reading or writing, please tell us.

I have difficulty with reading

I have difficulty with writing




Do you need this document in a different format? For any other
format including large print, audio CD/tape, Braille or translated into
another language please telephone 0113 214 1774



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