1. Personal Details Personal Details Title First Name Last Name Address Email Address Mobile number Alternative number 2. Eligibility for this role Eligibility for this role Are you a Southway tenant or leaseholder? Yes No Are you a Southway employee? Yes No Have you ever been a Southway employee? Yes No Do you have a spouse, partner or a close relative who is a Southway employee? Yes No Do you have a spouse, partner or a close relative who is a Southway Board or Committee Member? Yes No Are you an Elected Member of Manchester City Council or have you been within the last four years? Yes No Is your spouse, partner or a close relative an Elected Member of Manchester City Council, or have they been within the last four years? Yes No Are you an officer of Manchester City Council? Yes No If you have answered yes to any of the above questions please provide details here: 3. Your CV Your CV Please upload your current CV 4. Why you are right for the role Your Application Statement Which role are you applying for? Parent Board Member Board EDI Co-optee I am interested in both Please complete a short statement (ideally no more than 1000 words) explaining why you are a good candidate for the role. Please refer to the skills section of the Board Terms of Reference at Appendix A of the Recruitment Pack above. 3. Diversity Monitoring Diversity Monitoring Southway is committed to promoting equality and valuing diversity. We believe that our decisions and services are improved when they are informed by a wide range of experiences and perspectives. We want to make sure that we treat people fairly and do not allow any ‘unconscious bias’ to influence decisions in our recruitment processes. On going analysis of diversity statistics helps us to assess how we are doing and challenge ourselves to do better. It would be appreciated if you would complete this form. The information you provide will be used for monitoring trends about the people we attract to apply for this type of role and those we appoint. Any information you provide about disability can also be used to make reasonable adjustments to enable you to have a fair opportunity to be considered for the role. A. Age Your age If you prefer not to say, please write Prefer not to say. B. Disability Do you consider yourself to have a disability? The Disability Discrimination Act 1995 defines a disability as: “A physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities” Yes No Prefer not to say If 'Yes' please provide brief details of your disability and any reasonable adjustments you would require should you be invited to interview for this post. C. Ethnicity Please select your ethnicity from the drop down list below. If you wish to specify any other ethnicity use the box in the next question. (These are based on the Census 2011 categories and are listed alphabetically) Asian/Asian British Bangladeshi Chinese Indian Pakistani Any other Asian background (specify below if you wish) Black/African/Caribbean/Black British African Caribbean Any other Black/African/Caribbean background (specify below if you wish) Mixed/Multiple Ethnic Groups White and Asian White and Black African White and Black Caribbean Any other Mixed background (specify below if you wish) Other Ethnic Group Arab Any other ethnic group (specify below if you wish) White British/English/Welsh/Scottish/Northern Irish Gypsy or Irish traveller Irish Any other White background (specify below if you wish) I prefer not to say I prefer not to say If not listed in the Census 2011 categories above, please specify your ethnicity below: D. Gender At birth were you described as: (These are based on 2012 EHRC research report, Monitoring Equality: Developing a gender identity question) Female Male Intersex I prefer not to say Which of the following best describes how you think of yourself? Female Male In another way I prefer not to say E. Sexual orientation Which of the following options best describes how you think of yourself? Bisexual Gay/Lesbian Heterosexual/Straight I prefer not to say Other (specify below if you wish) Specify sexual orientation if you wish: F. Religion or Belief Which group do you most identify with? (These are based on the Census 2011 categories and are listed alphabetically) Buddhist Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Hindu Jewish Muslim No religion Sikh Any other religion or belief (specify below if you wish) I prefer not to say Specify religion if you wish: G. Legal marital or civil partnership status I am Married/In a civil partnership Not married/Not in a civil partnership I prefer not to say H. Carer status Do you perform a carer role? Yes No Do you have a dependent child/dependent children aged 16 or under? Yes No Prefer not to say 4. Privacy Information Submit form By submitting this form, you confirm that to the best of your knowledge the information you have provided is true, that you know of no reason why you would not be eligible to become a company director, and you consent to Southway carrying out reasonable enquiries to establish that you are eligible to become a Southway Board or Committee Member. If it is found that you have deliberately given false or misleading information, you are liable to be disqualified from further consideration or, if appointed, to be dismissed from the Board immediately and without notice. I confirm and agree I am not a robot Submit
