NORTH TYNESIDE 
COUNCIL	
Governor Application/Nomination Form
PARENT GOVERNOR – MARDEN HIGH SCHOOL
				
Please complete all sections of this form
Name:									Title:

Address:  ___________________________________________________________

___________________________________________________________________

Post Code:  _____________________	Tel. No. (Home)  _____________________

E-mail:  _________________________	Tel. No. (Work)  ______________________

Occupation:

Please tell us a bit about yourself and why you would like to be a school governor.
(The information in this section may be shared with the governing body/parents of children at the school)

										

Please give details of two nominees who will support your application (the nominees should be parents of children at the school).  The school reserves the right to take up references.

Name

Address

			Post Code

Tel No:
Occupation:	Name

Address

			Post Code

Tel No:
Occupation:

How did you hear about this vacancy:  ______________________________________________

GENERAL INFORMATION

Schools and the LA take their responsibilities with regard to safeguarding children very seriously.  You should be aware that relevant pre appointment checks will be undertaken and you will be asked to provide evidence to allow these checks to take place.

Governor Services follows CRB’s Code of Practice, copies can be provided upon request.

Governor Services has a Policy Statement on the Secure Storage, Handling, Use, Retention & Disposal of Disclosures and Disclosure Information, available upon request.

REHABILITATION OF OFFENDERS ACT 1974
DISCLOSURE OF PREVIOUS CONVICTIONS

This governor position is exempt from the Rehabilitation of Offenders Act 1974.  So you should tell us about any convictions you may have, even if they are considered to be ‘spent’ under this act. Please declare any convictions that have occurred, including any that have become spent under the Rehabilitation of Offenders Act.

We will keep in strict confidence any information we receive.  A criminal record will not affect your appointment as a governor unless it makes you unsuitable for appointment.  In making this decision, we will consider the nature of the offence, how long ago and what age you were when it was committed, and any other relevant factors, including the Council’s policies. 

A Policy Statement on the Recruitment of Ex-Offenders is available from Governor Services upon request.

DISQUALIFICATIONS

A person is disqualified from election or appointment as a parent governor of a school if they are an elected member of the LA or if they work at the school for more than 500 hours (i.e. for more than one-third of the hours of a full-time equivalent) in a school year (at the time of election or appointment).

A person is disqualified from holding or continuing to hold office as a governor or associate member if he or she:
•	Is under the age of 18 at the time of their election or appointment.
•	Already hold a governorship at the same school.
•	Is detained under the Mental Health Act 1983 during their period of office.
•	Fails to attend the governing body meetings – without the consent of the governing body – for a continuous period of six months, beginning with the date of the first meeting missed (not applicable to ex-officio governors)
•	Is subject to a bankruptcy restriction order or an interim order.
•	Has had their estate sequestrated and the sequestration order has not been discharged, annulled or reduced;
•	Is subject to:
-	a disqualification order or disqualification undertaking under the Company Directors Act 1986,
-	a disqualification order under Part 2 of the Companies (Northern Ireland) Order 1989,
-	a disqualification undertaking accepted under the Company Directors Disqualification (Northern Ireland) Order 2002,
-	an order made under Section 492(2)(b) of the Insolvency Act 1986 (failure to pay under county court administration order).
•	Has been removed from the office of charity trustee or trustee for a charity by the Charity Commissioners or High Court on grounds of any misconduct or mismanagement, or under Section 34 of the Charities and Trustees Investment (Scotland) Act 2005 from participating in the management or control of any body.
•	Is included in the list of people considered by the Secretary of State as unsuitable to work with children.
•	Is disqualified from registration for childminding or providing day care.
•	Is disqualified from registration under Part 3 of the Childcare Act 2006.
•	Has received a sentence of imprisonment (whether suspended or not) 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.
•	Has received a prison sentence of two-and-a-half years or more in the 20 years before becoming a governor.
•	Has at any time received a prison sentence of five years or more.
•	Has been fined for causing a nuisance or disturbance on school premises during the five years prior to or since appointment or election as a governor.
•	Refuses to allow an application to the Disclosure & Barring Service (formerly the Criminal Records Bureau) for a criminal records certificate.

I declare that none of the disqualifications apply to me, and that if any do become applicable whilst I am serving as a governor I will immediately inform Governor Services and resign.

Signature:	______________________________________  Date:  ____________

Please return to:  Mrs A Davidson, Marden High School, Hartington Rd, North Shields 
NE30 3RZ  or  email to:   a.davidson@mardenhigh.net