MIDDLETOWN CENTRE FOR AUTISM
POSITION: DIRECTOR
APPLICATION FORM
Completed applications MUST arrive no later than
12 noon on 12 November 2015
LATE APPLICATIONS WILL NOT BE ACCEPTED
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To ensure equality of opportunity everyone must comply with the word limitations
set for each individual section. Applicants must not amend the format or structure of
the application form. The selection panel is unlikely to consider application forms
that do not conform to these requirements;
Typewritten or e-mailed applications are welcomed. Applicants are recommended
to complete the application form in font size 12 or handwritten in legible
handwriting using black ink;
If your application is submitted by e-mail we will require you to sign the form if
invited to interview.
Please do not add additional information, including CVs, letters or other
supplementary material to the application form.
We would advise you to retain a copy of your application for your own information.
Applications will not be examined until after the closing deadline.
Completed hard copy or electronic versions of the application form will be accepted.
Please return the completed application form and monitoring form to:
Terence Dorrian,
Room G17a,
Rathgael House,
Bangor, BT19 7PR, or
Email to: terry.dorrian@deni.gov.uk
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Personal Information
PERSONAL DETAILS
Surname: (Block letters)
Forenames: (underline name
you are known by)
Title:
(Prof/Dr/Mr/Mrs/Ms
etc.)
Telephone:
Mobile telephone:
e-mail address:
Permanent Address:
Address for Correspondence: (if different
from Permanent Address)
Postcode:
Postcode:
How do you want us to contact you?
By e-mail
(please Xas appropriate)
By post
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Guaranteed Interview Scheme
We are operating a Guaranteed Interview Scheme (GIS) for this appointment process.
Applicants with a disability who demonstrate that they meet all of the essential criteria
for this appointment will be invited for interview.
The Disability Discrimination Act 1995 defines a person with a disability as someone
who has a physical or mental impairment which has a substantial and adverse long term
affect on their ability to carry out normal day to day activities.
Please put an X in the box below if you wish to be considered under the GIS.
GIS Declaration
I consider myself to have a disability as defined above and I would like to
apply under the GIS. I understand that a false declaration of a disability in
order to obtain an interview will invalidate my application.
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Please let us know if you require any reasonable adjustments, or arrangements to
enable you to attend for interview. The selection panel will only be advised of any
adjustments they need to know about in order to manage the interview.
OTHER INFORMATION
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Have you ever been convicted of a criminal offence (other than minor motoring
offences) which is not spent in accordance with the Rehabilitation of Offenders Act
1974?
Are you the subject of any legal, criminal or statutory investigations or actions, or
are any pending?
Have you have been adjudicated bankrupt or made a composition or arrangement
(such as those set out in Note 1 below) with your creditors over the past 10 years?
Were you dismissed from any public office over the past 10 years?
Have you been disqualified from acting as a company director or had any
conditions imposed upon you in the conduct of a company; or are under
investigation in relation to a potential director’s disqualification; or were/are a
director or partner of a company which has gone into liquidation, receivership or
administration?
Please tick as appropriate:
Yes
No
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If yes, please provide details below
Note 1:
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Individual Voluntary Arrangements (IVAs) and Fast-Track Voluntary
Arrangements (FTVAs);
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Bankruptcy Restrictions Orders or Undertakings (BROs/BRUs);
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Debt Relief Orders (DROs); and
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Debt Relief Restrictions Orders or Undertakings (DRROs/DRRUs).
DECLARATION
I understand that a candidate found to have given false information or wilfully to have
suppressed any material fact will be liable either to disqualification or, if appointed, to
dismissal.
I have read the leaflet entitled “Probity and Conflicts of Interest – Guidance for
Candidates” and the information pack and have completed the relevant section of this
form as appropriate. I understand that, if appointed, I must raise with the Chair of the
Middletown Centre for Autism’s Board of Directors and the Department of Education
any probity or conflict of interest issues that might arise during my term of appointment
and that my failure to do so could lead to my appointment being terminated.
I declare that the information I have given in support of my application is true and
complete to the best of my knowledge. I understand that, if I am appointed and the
information I have provided is incorrect, or any of the statements made in this
declaration are untrue, or subsequently circumstances arise at any time before the end
of my term in office which would render any such statements untrue, then my tenure of
office may be terminated.
I understand and accept that the information I have provided in this form will be
processed by the Department of Education, in accordance with its Data Protection
Registration, for the purposes of making public appointments and that this may involve
disclosing information to other Government departments and the Commissioner for
Public Appointments for NI.
I understand and accept that should I be appointed some of the information I have
provided will be placed in the public domain.
Signature:
Date:
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SKILLS, KNOWLEDGE AND EXPERIENCE
Please read the Information Pack in full before carefully before completing the
form.
Only those applicants who appear, from the information provided, to be the most
suitable in terms of the selection criteria may be called for interview.
Drawing on your working, public or personal life, demonstrate how your experience
fulfils the following criteria. Please read carefully the notes in the Person
Specification in the Information Pack before completing the application form.
It is your responsibility to demonstrate clearly on your application form how you
satisfy the published selection criteria. It is essential that you provide evidence of
how you meet the selection criteria, giving examples and specifying exact dates as
appropriate.
It is not sufficient to simply list the various posts that you have held. The selection
panel cannot make assumptions as to your skills, knowledge and experience from
the title of previous posts held.
Please note that if all sections of the application form are not completed in
accordance with the guidance provided in this Information Pack, we will be unable to
proceed with your application. Applicants must not amend the format or structure of
the application form. Supplementary material such as CVs or testimonials will not be
considered and should not be provided.
This part of the application form is anonymous.
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CURRENT COMMITMENTS
Please provide details of all your current commitments including employment, company
directorships, voluntary activity and any other information you consider relevant to this
appointment. (This information will be used to help identify any potential conflicts of
interest).
CURRENT PUBLIC APPOINTMENTS
Please list all current public appointments.
Public
Appointment
Position Held
Date first
appointed
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Remuneration
SELECTION CRITERIA
You should complete each of the following three essential criteria and the
desirable criteria.
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1.
Working with Others - Developing and maintaining cooperative working
relationships to achieve high standards of service and results
Provide evidence drawing on your experience of a team of which you are or have
been a member, and the contribution you have made to the success of that team.
Maximum 400 words.
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2.
Thinking Strategically - Making a significant contribution to the strategic
direction of the organisation
Provide evidence drawing on your experience that demonstrates your ability to
contribute to organisational goals and objectives and which demonstrates the
consideration you gave to the link between the budgeting and business planning
process. Maximum 400 words.
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3.
Analytical Thinking - Making decisions and solving problems in a team
and organisational environment
Provide evidence drawing on your experience that demonstrates your ability to
agree a decision or solve a problem in a team and which demonstrates the
consideration you gave to its related resource implications. Maximum 400 words
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DESIRABLE CRITERIA
4.
Relevant Experience
Provide evidence drawing on your experience that demonstrates your ability in
one of the following fields:
i.
Special education and/or autistic spectrum disorders.
ii.
Financial administration, management and/or accountability.
iii.
Business planning and organisational development.
Responses must be confined to the size of the box on this page.
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PROBITY AND CONFLICTS OF INTEREST
Before you complete this section, it is important that you read the leaflet entitled
“Probity and Conflicts of Interest – Guidance for Candidates” (enclosed with your
application documents) and the material which is included in your information
pack in Section 6.
Have you, or your immediate family, any business or other interests or personal
connections which might be construed as being in conflict with the appointment
for which you have applied?
Are there any probity issues, which if raised in public, might cause
embarrassment or reputational damage for you, the Middletown Centre for
Autism or the Department of Education (DE)?
Please tick as appropriate:
Yes
No
If yes, please provide details below
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