APPLICATION FORM FOR THE POST OF

CHIEF EXECUTIVEJANUARY 2020

Guidance notes on completing your Application Form

Please complete the Application Form provided to ensure an equitable recruitment process. CVs in lieu of the Application Form cannot be accepted.

The Application Form is designed to ensure that applicants provide the necessary information to determine how they meet the requirements of the role and the shortlisting criteria.

You should ensure that all sections of the Application Form are completed.

You should ensure that you provide evidence of your relevant experience in your Application Form, giving length of experience, examples and dates as required.

It is not sufficient to simply list your duties and responsibilities or to simply state that you meet the criteria as this must be fully demonstrated in response.

Cancer Focus NI will not make assumptions from the title of the applicant’s post or the nature of the organisation as to the skills and experience gained.

Write down clearly your personal involvement in any experience you quote. Write “I” statements e.g. I planned meetings, I managed a budget, I prepared a presentation. The panel will be interested in hearing how you actually carried out a piece of work.

The examples you provide should be concise and relevant to the criteria. This is very important as the examples which you provide may be checked out at interview and you may need to be prepared to talk about these in detail if you are invited to interview. It is your unique role the panel are interested in, not that of your team or division.

If you do not provide sufficient detail, including the appropriate dates needed to meet the eligibility criteria, the selection panel will reject your application.

Only the details provided by you in your Application Form (the employment history and eligibility criteria) will be provided to the selection panel for the purpose of determining your eligibility for the post.

The quality of your written English will also be assessed as part of the application process.

It is preferable to complete the form using MS Word before printing it and signing the hard copy. If you choose to handwrite it, please do so legibly using black ink. If you need to continue any section onto a separate sheet, please mark that sheet clearly with the number of the section to which it refers. Do not enclose any material other than that requested.

In order to be considered for this post, a signed hard copy of your completed Application Form must be returned by our closing date of:

Noon, Monday 3 February 2020

Completed Application Forms should be submitted to:

Patrick MinneDirectorEngage Executive Talent31 Bruce StreetBelfast BT2 7JD

1

2

PLEASE COMPLETE ALL SECTIONS

1. Personal Details

Surname:(Block Letters)

Forename(s):(Please underline name by which you are known)

Title:(Mr / Mrs / Miss / etc)

Home Address: Address for Correspondence:

Post Code: Post Code:

Contact Details Transport and IT

Home:Do you hold a full, current driving licence with business insurance and have access to the use of a car or some other appropriate form of transport to carry out the duties of the post in full?

Yes / NoMobile:

Email:Do you have IT literacy, proficiency with Microsoft Office, including Outlook, Word, Excel and PowerPoint?

Yes / No

Eligibility to work in the UK

Do you require a work permit to work in the EU?

Yes / No

If yes, please give details.

3

2. Academic and Professional Qualifications and Registrations

Please detail degree level qualifications, professional qualifications and/or current professional registrations

Awarding Body Description Date Awarded

4

3. Employment History

Current Employment (If not in employment, most recent post)

Name and address of current employer Job Title Date appointed

(dd/mm/yy)

Name:

Address:

Current Basic Salary List other current package benefits(e.g. pension, health care, car allowance etc)

Period of Notice Required

£

Reason for leaving and leaving date, if applicable

Principal duties (maximum 200 words)

Past Employment

List in reverse chronological order.

Employer Name and Employment Dates

From dd/mm/yy To dd/mm/yy

Position Held and Description of Main Responsibilities

Bullet points please

Reason for Leaving:

5

Continue on a separate page if necessary6

4. Selection Criteria

The following sections ask you to outline how you meet the essential criteria and, where relevant, desirable criteria to be used by the panel when shortlisting for interview. You must clearly demonstrate how you meet each criterion giving relevant examples and providing full details of any relevant qualifications with the grade or level obtained. The shortlisting panel will not make assumptions as to your qualifications, experience, circumstances, skills and/or knowledge. Refer to guidance notes (p1).

Essential Criteria: 4.1 Please demonstrate here how you meet the requirement to have a degree level qualification

Essential Criteria: 4.2Please describe your proven track record in senior management reporting directly to a Board or at Senior Director level, in no more than 300 words

Essential Criteria: 4.3

Please tell us how you meet the requirement to have strong strategic planning, prioritisation and execution skills, with the proven ability to manage multiple objectives, competing demands and monitor progress and impact through the development of operational plans in no more than 500 words

Essential Criteria: 4.4 Please describe your proven track record of securing resources to deliver organisational goals, in no more than 300 words

7

Essential Criteria: 4.5Please explain your significant financial management experience and experience of managing multiple budgets and resources, in no more than 300 words

Essential Criteria: 4.6Please demonstrate your proven track record of creating an empowering work culture that rewards performance and ensures accountability at every level within the organisation, in no more than 300 words

Essential Criteria: 4.7Please evidence your strong decision-making skills, including a willingness to confront tough management issues when necessary, in no more than 300 words

Essential Criteria: 4.8Please describe your ability to analyse, solve problems and implement change, with a successful track record of managing and delivering change, in no more than 500 words

8

Essential Criteria: 4.9Please describe your demonstrable track record of having managed a team to deliver an organisation’s strategic and operational goals, in no more than 300 words

Essential Criteria: 4.10

Tell us how you have demonstrated your exceptional written and verbal communication skills, with the ability to distil complex ideas in ways that inspire and engage a diverse range of audiences, including through the media, in no more than 300 words

Desirable Criteria: 4.11 Please tell us about any experience you have of managing a budget greater than £500,000, in no more than 300 words

Desirable Criteria: 4.12Please tell us about your proven track record of securing resources to deliver organisational goals and deliver growth, in no more than 300 words

Desirable Criteria: 4.13Describe your track record of having managed a multidisciplinary team to deliver an organisation’s strategic and operational goals, in no more than 300 words

9

10

Referees

Please name two referees who have knowledge of your present and/or most recent work and who are in a supervisory managerial capacity. (Please note that referees will not be contacted until a candidate is selected as final preferred candidate.)

Name:

Occupation:

Relationship to Referee:

Address:

Postcode:

Telephone Number:

Email:

Name:

Occupation:

Relationship to Referee:

Address:

Postcode:

Telephone Number:

Email:

Personal Declaration

I declare that to the best of my knowledge, the information given is honest and accurate. I understand that any willful misstatement or omission renders me liable to disqualification or, if appointed, to dismissal.

I understand that the appointment is subject to receipt of satisfactory references, the verification of qualifications required for the post (as per the Person Specification) and the relevant check on the Disclosure of Criminal Convictions.

I hereby give consent for the information on this form to be collected, stored and processed in accordance with the provisions of the Data Protection Act 1998 and the General Data Protection Regulation.

Signed: Dated:

11

Consent to Disclosure of Criminal Convictions

We reserve the right to and will only seek such information in respect of persons to whom we have made a conditional offer of employment.

We will treat the information with the utmost sensitivity and confidentiality.

We will not withdraw a conditional offer of employment merely because a person has a criminal record. We will keep an open mind and will make a final decision following a risk assessment.

I understand that if I am shortlisted for interview I will be required to complete a self-disclosure of criminal convictions. I understand that as per the Access NI Code of Practice, Cancer Focus NI must ask me to disclose if there is any reason why I cannot work in regulated activity.

The information provided will not be discussed at the interview itself. A separate arrangement will be made if clarification is required.

A criminal record will not necessarily be a bar to obtaining a position.

I hereby give my consent

Signed:

Dated:

Please return within your main application pack.

Reference number:

(Internal use only)

1

Equal Opportunities Monitoring Form

Confidential

Reference number:________________ (Office use only)

Monitoring Questionnaire

Guidance Notes:

We are an Equal Opportunities Employer. We aim to provide equality of opportunity to all persons regardless of their religious belief; political opinion; sex; race; age; sexual orientation; or, whether they are married or are in a civil partnership; or, whether they are disabled; or whether they have undergone, are undergoing or intend to undergo gender reassignment.

We do not discriminate against our job applicants or employees on any of the grounds listed above. We aim to select the best person for the job and all recruitment decisions will be made objectively.

In this questionnaire we will ask you to provide us with some personal information about yourself. We are doing this for two reasons.

Firstly, we are doing this to demonstrate our commitment to promoting equality of opportunity in employment. The information that you provide us will assist us to measure the effectiveness of our equal opportunity policies and to develop affirmative or positive action policies.

Secondly, we also monitor the community background and sex of our job applicants and employees in order to comply with our duties under the Fair Employment & Treatment (NI) Order 1998.

You are not obliged to answer the questions on this form and you will not suffer any penalty if you choose not to do so.

Nevertheless, we encourage you to answer the questions below. Your identity will be kept anonymous and your answers will be treated with the strictest confidence. We assure you that your answers will not be used by us to make any unlawful decisions affecting you, whether in a recruitment exercise or during the course of any employment with us. To protect your privacy, you should not write your name on this questionnaire. The form will carry a unique identification number and only our Monitoring Officer will be able to match this to your name.

2

Community Background:

Regardless of whether they actually practice a particular religion, most people in Northern Ireland are perceived to be members of either the Protestant or Roman Catholic communities.

Please indicate the community to which you belong by ticking the appropriate box below:

I am a member of the Protestant community

I am a member of the Roman Catholic community

I am not a member of either the Protestant or the Roman Catholic communities

If you do not answer the above question, or if you tick the “not a member of either” box, we are encouraged to use the residuary method of making a determination, which means that we can make a determination as to your community background on the basis of the personal information supplied by you in your Application Form/personnel file.

Please indicate your sex by ticking the apporpriate box below

Male

Female

Note: If you answer these questions about community background and sex you are obliged to do so truthfully, as it is a criminal offence under the Fair Employment (Monitoring) Regulations (NI) 1999 to knowingly give false answers to these questions.

Age

Please state your date of birth: _________________________________________

Racial Group

Please state your country of birth: _________________________________________

Please state your country of nationality: _________________________________________

Please tick which of these apply to you

White Chinese Irish Traveller

Indian Pakistani Bangladeshi

Black Caribbean Black African Black Other

Mixed ethnic group (please state which): ________________________________

Any other ethnic group (please state which): ________________________________

3

Disability

Under the Disability Discrimination Act 1995 you are deemed to be a disabled person if you have cancer, multiple sclerosis or HIV infection.Also, you are deemed to be a disabled person if you have a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.

Do you consider that you are a disabled person?

Yes No

If you answered “yes”, please indicate the nature of your impairment by ticking the appropriate box or boxes below:

Physical impairment, such as difficulty using your arms, or mobility issues requiring you to use a wheelchair or crutches

Sensory impairment, such as being blind or having a serious visual impairment, or being deaf or having a serious hearing impairment

Mental health condition, such as depression or schizophrenia

Learning disability or difficulty, such as Down Syndrome or dyslexia, or cognitive impairment such as autistic spectrum disorder

Long-standing or progressive illness or health condition, such as cancer, HIV infection, diabetes, epilepsy or chronic heart disease

Other (please specify)

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Sexual Orientation

Please indicate your sexual orientation by ticking the appropriate box below:

I am straight

I am gay or lesbian

I am bisexual

4

Marital Status/Civil Partnership Status

Are you married or in a civil partnership?

Yes No

Dependants / Caring Responsibilities

Do you have dependants, or caring responsibilities for family members or other persons?

Yes No

If you answered ‘Yes’, are your dependants or the people you look after:

A child or children

A disabled person or persons

An elderly person or persons

Other

If other, please specify

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

5