Nomination Form for Existing Directors Aspire Together: London Talent Pool Existing Directors 1 Privacy Agreement2 Contact Details3 Nomination4 Job Role5 Nominated Executive Leader6 Talent Conversation7 Supporting Documents8 Equality & Diversity9 Agreement10 Summary Application-ID Optional Application-ID Optional 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.Please check the box below to accept our Data Privacy Policy I confirm I have read and accept the Academy’s Data Privacy Policy Contact DetailsName First Last Email Your primary email addressPost Code Your home post codePhone Your main telephone number with international dialing code and extension if necessary Nomination How were you nominated for the Aspire Together Talent Pool: Existing Directors? My organisation nominated meI put myself forward Job Role Please enter the details of your current main job role.Organisation CountryEnglandNorthern IrelandScotlandWalesOutside UK Organisation Type Organisation Name Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePlease select your countryOrganisation Type Please enter the type of organisationNew OrganisationHidden section that is only shown when the organisation is unknownOrganisation Name Please enter the name of the organisationOrganisation Post Code Please enter the post code of the organisationIs this an NHS organisation? YesNoRole Staff GroupAdditional Clinical ServicesAdditional Professional Scientific & TechnicalAdministrative & ClericalAllied Health ProfessionalsEstates & AncillaryHealthcare ScientistsMedical & DentalNursing & Midwifery RegisteredStudent Job Title Job Title Please enter your job titleSalary/Band Band 1 or £17,460Band 2 or £17,460 - £18,702Band 3 or £17,787 - £20,448Band 4 or £20,150 - £23,363Band 5 or £23,023 - £29,608Band 6 or £28,050 - £36,644Band 7 or £33,222 - £43,041Band 8a or £42,414 - £49,969Band 8b or £49,242 – £59,964Band 8c or £59,090 - £71,243Band 8d or £70,206 - £85,333Band 9 or £84,507 - £102,506Band VSM or £98,545 and overOther Salary/BandDo not wish to disclose Nominated Executive Leader Please provide the details of your line manager or Nominated Executive Leader (Chief Executive / Accountable Officer / Regional Director). Please note the nominated executive needs to be operating at Chief Executive or Chair level. If self-nominating they may well be an executive or Human Resource Director (or equivalent).Name First Last Email Phone Role Staff GroupAdditional Clinical ServicesAdditional Professional Scientific & TechnicalAdministrative & ClericalAllied Health ProfessionalsEstates & AncillaryHealthcare ScientistsMedical & DentalNursing & Midwifery RegisteredStudent Job Title Job Title Please enter your nominated senior leader's job title Career Conversation As part of the nomination process, we highly recommend that individuals have discussed their career aspirations with a senior leader (someone typically working at an executive level or equivalent). It is important to remember that a career conversation is not a performance management discussion and should be a jointly agreed process. We suggest you follow these steps: Hold a career / talent conversation using your organisation’s talent management processes and tools or, those produced by the Leadership Academy with your ‘Nominated Executive Leader’ (board / governing body executive director or equivalent).You can access the NHS Leadership Academy Talent Management Guide below: Leadership Academy Talent Management Conversation Tool Consider your skills, knowledge and experience against the Success Profile such that where possible you can both agree you are ready for your next board / governing body executive director level role. Please note that we do not expect you to have all of the competencies and experiences listed in the Success Profile and understand that we need different styles and types of leadership. We'll be looking for those who understand the board / governing body executive director role, have a good range of experience and demonstrate a range of strengths in the competencies. Please note below whether you were able to hold a career conversation and which talent conversation tool you used.Write your answers here Supporting documentsPlease upload the following documents: Your completed Success Profile Review (Mandatory) Your completed Nominated Executive Leader sign-off (Mandatory) Drop files here or 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. The Regional Talent Boards are committed to improving equality, diversity and inclusion in talent management across the NHS. By answering these questions, you are helping us to ensure that we work in a way that reduces discrimination on the basis of race, gender, sexual orientation, disability and other protected characteristics. Any data we hold is stored securely and in compliance with the General Data Protection Regulation (GDPR) 2016. If you have any questions or concerns about the collection of this data, please contact aspire.togetherlondon@nhs.netWhich of the following best describes your gender? FemaleMaleAnother genderDo not wish to discloseAre you now or have you ever defined yourself as Transgender? YesNoDo not wish to discloseWhich of the following best describes your sexuality? Another sexualityAsexualBisexualGayHeterosexualLesbianDo not wish to discloseDo you consider yourself to have a disability? YesNoDo not wish to discloseWhich of the following best describes your ethnic background? Asian or Asian British - Any other Asian backgroundAsian or Asian British - BangladeshiAsian or Asian British - IndianAsian or Asian British - PakistaniBlack or Black British - Any other Black backgroundBlack or Black British - AfricanBlack or Black British - CaribbeanMixed - Any other Mixed backgroundMixed - White and AsianMixed - White and Black AfricanMixed - White and Black CaribbeanOther ethnic group - ChineseWhite - Any other White backgroundWhite - BritishWhite - IrishAny other ethnic groupDo not wish to discloseWhich of the following best describes your religion or belief system? AtheismBuddhismChristianityHinduismIslamJainismJudaismSikhismOtherNot religiousDo not wish to disclose AgreementPlease check the box below to accept our Terms and Conditions Regional Talent Board Terms & Conditions 1. I confirm that all the information provided in the Nomination Form is up to date and accurate. 2. I understand that by applying I am identifying myself as an individual looking for a new role in the NHS or Healthcare Sector which may include NHS England and NHS Improvement, Health Education England or Public Health England. 3. I understand that by submitting this nomination I am agreeing to be supported by NHS Executive Search to gain my next executive position. 4. My personal data will be kept confidential; however, my name will be known to the Regional Talent Board members should you be ready to be placed within an executive talent pool. (NB – this will be explained in detail following profiling processes). 5. If organisationally sponsored: Your executive sponsor is supportive of your application and will enable you to take part in all elements of the gateway process. 6. If self-nominating: You agree that you are able to attend take part in all elements of the gateway process (e.g. manager support) 7. I will ensure I provide feedback for evaluation purposes when asked to do so, recognising that this will help inform future development of the Gateway Assessment Process. 8. I agree to advise the Aspire Together team as soon as possible if I am successful at interview elsewhere or if I am no longer looking to join the Talent Pool and that this will result in withdrawal from the process. 9. I understand that my information will be used for reporting purposes as part of the NHS Leadership Academies work. 10. I understand that if at any time I wish my contact details not to be shared I must advise in writing that I do not wish this to happen. Any requests should be made to: aspire.together@nhs.net. 11. I understand that the Aspire Together team will be in touch to discuss my application. This will be to discuss some of the information contained within this form and only if we feel that we need more detail from you. This will be via the contact details I have shared in this form or otherwise stated. 12. I understand that I may be contacted during the process and following assessment regarding (but not limited to) potential development opportunities and various programmes, workshops, newsletters or networking events which may be of interest to me in developing my career. I agree to the Terms and Conditions SummaryPlease check your details and, if correct, submit this form. {all_fields:value,nohidden,noadmin} Problems? For technical support email support@leadershipacademy.nhs.ukOtherwise call 07747007604 or email London RTB