FOR OFFICE USE ONLY: Acknowledged? Fee: CRM Updated?

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Abner Little
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1 FOR OFFICE USE ONLY: Acknowledged? Fee: Logged? CRM Updated? Invoice.

2 Completed Forms must be received by rth of Personal details please complete or tick the boxes as appropriate: Your first and last name: How your name is to appear on your certificate: Your employer: Your employer s address (including the postcode): Your position in your organisation: The nature of your organisation: The number of employees (approximately): Your work address: Your personal address (optional): Preferred contact address: Work Own Both Your work phone number.: Your mobile phone number (optional): Your home telephone number (optional): May we add you to our mailing list? (te that we will not give your details to any third party without your permission.) Is your employer a Joint EE / BQF Member? Have you assessed for the rth of England Excellence Awards before? Fee payable (exc. VAT): NOVICE (Less than 250 Employees); Member: 535; CQI: 695; n-member: 795 NOVICE (250 or more Employees): Member: 695; CQI: 795; n-member: 895 EXPERIENCED Member: 195; CQI: 245; n-member: 275 te that participation in the 2015 rth of England Excellence Awards as an Assessor is conditional on receipt of the appropriate fee. PAYMENT OPTIONS Option 1 - Card Payment * Name as it appears on card Card Number State Card Type ** Expiry Date Security code / Issue. * There will be a surcharge of 2.8% when paying by Credit Card ** Unfortunately we do not accept American Express Option 2 - Cheque Payment Option 3 Invoice against Purchase Order.: Name of Authorising Budget Holder: Billing Name: Billing Address (inc. post code) (if different from above): Page 2 of 5

email address (optional): Preferred contact email address: Work Own Both Your work phone number.

3 Completed Forms must be received by rth of This page needs to be completed by all new Assessors, by those experienced Assessors who have not previously assessed for the rth of England Excellence Awards, and by any former rth of England Award Assessors who have not assessed since Previous Business Excellence and/or related experience: Please briefly set out any experience of Total Quality or Change Management, Business Excellence and/or the EFQM Excellence Model; and of associated topics such as Investors in People and Quality Assurance. You should indicate any relevant time scales and/or durations. (Please type or write in this box, which will expand if required.) Previous Excellence Assessor experience: Please list any in-house, EE (or other Regional), UK or European level Assessor experience, giving the year(s). Please also indicate if you were a Lead (or Senior) Assessor. (Please type or write in this box, which will expand if required.) Page 3 of 5

Previous Business Excellence and/or related experience: Please briefly set out any experience of Total Quality or Change Management, Business Excellence and/or the EFQM Excellence Model; and of

4 Completed Forms must be received by rth of Lead / Deputy Lead Assessor selection Would you like to be considered for the role of Deputy Lead Assessor for the 2015 rth of England Excellence Awards? Would you like to be considered for the role of Lead Assessor for the 2015 rth of England Business Awards? A Briefing for all potential Lead and Deputy Lead Assessors will be held at the IBC, Warrington on the morning of Friday 24 th April Are you available to attend this if selected? If you are a new assessor please indicate your preferred dates: Training for vice Award Assessors Venue: International Business Centre, Delta Crescent, Warrington WA5 7WQ Available Dates: Please indicate your choice(s): Wednesday and Thursday 15 th and 16 th April st 2 nd Wednesday and Thursday 22 nd and 23 rd April st 2 nd 2015 Assessment Schedule All Assessors will be required to attend one of the one day assessor team events. Each session will start at 9.00am, but the finish time will be as determined by each team. Please indicate both your 1 st and 2 nd choices, and keep all these dates clear in your diaries. One day Award Assessor Team Session Venue: International Business Centre, Delta Crescent, Warrington WA5 7WQ Available Dates Please indicate your choices: Wednesday 13 th May st 2 nd Wednesday 20 th May st 2 nd Whilst we will do our best to assign you to your 1 st choice event the need for an appropriate mix of Assessors in each team may mean that this may not be possible. Site Visits: Whilst the dates of each site visit will be agreed between the Assessor Team and the Applicant, all Site Visits will be completed by Friday 10 th July Assessment Reports: All Assessment Reports will be completed and submitted to rth of England Excellence as soon as possible following the site visit, and by Friday 24 th July 2015 at the latest. Other key dates: 2015 Jury Meeting: This is scheduled for Friday 4 th September Awards Ceremony & Gala Dinner: This is to be held on Thursday 12 th vember Feedback Reports: These will be released to Applicants on Monday 16 th vember Page 4 of 5

A Briefing for all potential Lead and Deputy Lead Assessors will be held at the IBC, Warrington on the morning of Friday 24 th April 2015. Are you available to attend this if selected?

5 Completed Forms must be received by rth of Applicant Assessor s Declaration 1. I understand that acceptance onto the 2015 rth of England Excellence Award Assessor Programme carries with it no guarantee that I will be assigned an Applicant organisation to assess as this is dependent on the actual number of organisations entering for the 2015 Awards. 2. I also understand that if accepted onto the Programme I will be invoiced in accordance with the charges quoted above, that these charges must be settled prior to the start of my participation in the programme, and that they are not refundable once paid. I accept the conditions set out above and confirm that the invoice for my fees will be settled in full prior to my attending the event(s) indicated elsewhere on this Form. Name Date Please ensure that your Application is received by rth of England Excellence by Friday 27th March rth of England Excellence will evaluate all Applications, determine the acceptability of each applicant, and notify the acceptance or otherwise of each application confirming the vice Assessor Training dates if appropriate within two weeks of receipt. Assessor Team Session dates will then be notified in due course. Completed 2015 Award Assessor Application Forms should be returned to: Suzanne House, Director Marketing, rth of England Excellence International Business Centre, Delta Crescent, Warrington WA5 7WQ Contact details: Telephone: Fax: [email protected] Website: Page 5 of 5

dependent on the actual number of organisations entering for the 20

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