RIGHT TO BUILD TASK FORCE Expression of interest to become an Expert 1. Your personal details Surname (required) First name (required) Address for correspondence (if different) Permanent Address and Postcode (required) Telephone (required) Your Email (required) Are we able to contact you at work? (checked box means yes) By PhoneBy Email Do you hold a current full car driving licence? YesNo 2. Your reasons Give your reasons for wanting to become a Right to Build Task Force Expert (required) 3. Your expertise competence Please describe how you think you meet three or more of the Expert selection criteria/competencies outlined in the letter of invitation (required) 4. Your experience Is there any other experience you think you can bring to the Task Force as an Expert. For example do you have international experience in Custom and Self Build development and/or specific knowledge of sites/opportunities you could introduce to the Task Force to provide support? (required) 5. Type of expert Briefly describe why you think you are an expert in your field. Please state whether you consider yourself an advisor, enabler, facilitator and/or active participant in the delivery of Custom and Self Build housing. (required) 6. Present/Most Recent Employment Details Employer’s Name (required) Employer’s Address (required) Job Title (required) Date Appointed (required) Date Terminated Summary of main duties/purpose of job (required) 7. Other Employment History Other relevant Employment history to support your Expression of Interest 8. Personal or Employed capacity Will you be an Expert in a personal capacity? If in an employed capacity, would your current Employer agree to release you on a time limited basis to act as a Right to Build Task Force Expert (subject to agreeing suitable terms)? (required) 9. Details Qualifications/Membership of Professional Bodies Dates and Details 10. References Please give three Referees who can comment on your experience. References will only be taken up for potential Experts that have been shortlisted and once they have been notified) First Referee with name, address, position and telephone/email (required) Second Referee with name, address, position and telephone/email (required) Third Referee with name, address, position and telephone/email (required) 11. How did you find us Please state where you heard about the Right to Build Task Force 12. Criminal Convictions (Rehabilitation of Offenders Act) Have you any convictions which are not regarded as "spent" under the Rehabilitation of Offenders Act 1974? YesNo Are you currently the subject of any criminal proceedings or convictions? YesNo If yes, please describe the offence and date of conviction and send this to us in a separate document from this form. Disclaimer All information supplied on this form will be used solely by the Task Force to assess your suitability to be an Expert and will not be discussed with parties outside the Task Force without your agreement. Accept by checking this box. I declare that the facts given in this Expression of Interest to become a Right to Build Task Force Expert are to the best of my knowledge correct. I understand that any false information may, if appointed as an Expert, result in termination of Expert Panel membership.