CEDN Application Form

1Privacy Agreement

2About you

3Employment Information

4Equality and Diversity

5Keeping in Touch

6Summary

Application-ID
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Submission Date
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Privacy Agreement

Any information you provide in completing this application will be stored and processed in accordance with our Data Privacy Policy which you are required to read and accept before completing your application.

By proceeding with this application, you agree that The Leadership Academy may contact you if you have partially completed your application to offer guidance and support with finishing your application.
This is a separate agreement to the marketing preferences selected further in this application.
Please check the box below to accept the above agreement and our Data Privacy Policy(Required)
I confirm I have read and accept the Academy’s Data Privacy Policy and above agreement

Employment Information
Please enter the details of your current main job role.
Organisation Region(Required)
Country(Required)
Please select your country
Organisation Name(Required)

The name of your organisation

Primary Role The primary role of your organisation

Postcode
The postcode of your organisation
Is this an NHS organisation?(Required)

Yes

No
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Organisation
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Organisation Type
Please enter the type of organisation
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New Organisation
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Organisation Name
Please enter the name of the organisation
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Organisation Post Code
Please enter the post code of the organisation
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Are you a CEO?(Required)

Yes

No
Role(Required)
Other Role:
Area of work(Required)
Job Title(Required)
Please enter your job title
Salary/Band(Required)

Equality & Diversity
We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for. Each programme is held to account for its inclusion practice through a review of anonymised statistics based on this data. Your equality and diversity data is not used to determine the success of your application. This data is stored securely in compliance with the General Data Protection Regulation (GDPR) 2016.
Which of the following best describes your gender?(Required)
Are you now or have you ever defined yourself as Trans?(Required)
Which of the following best describes your sexual orientation?(Required)
Which of the following best describes your ethnic background?(Required)
Which of the following best describes your religion or belief system?(Required)
Which of the following best describes your nationality?(Required)
Age(Required)
Do you consider yourself to have a disability?(Required)
Many people do not consider themselves to be disabled. However under the Disability Discrimination Act 1995 and the Equality Act 2010, you are protected from discrimination if you have a physical or mental impairment or long term health condition, the effects are expected to last – or have lasted – for a year or longer and have a substantial impact on your ability to carry out day to day activities; or your day to day activities would be limited without medication, treatment or adjustments (for example the use of inhalers, physiotherapy, a hearing or visual aid or insulin). Taking this into account, do you consider yourself to have a disability?
About your disability

Newly appointed Chief Executive support

Privacy Agreement

Please note this form is closed and applications will not be counted

About you

Employment Information

New Organisation

Equality & Diversity

Keeping in touch

Summary

Summary