Application Form

1Privacy Agreement

2About you

3Employment Information

4Equality, Diversity & Inclusion

5Your CEO Journey

6Your Files

7Keeping In Touch

8Terms and Conditions

9Summary

Application-ID
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Submission Date
DD dash MM dash YYYY
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 NHS 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

Please note this form is closed and applications will not be counted
About you
Name(Required)
First Last
Preferred Name
Preferred Email(Required)

Your primary email address
Preferred contact number(Required)
Your main contact number with international dialling code and extension if necessary
Please enter your 10-digit Academy ID(Required)

If you already have an Academy ID, please log on to our new Academy Profile system using your existing log in details to ensure your account is transferred to our new system.

If you need help remembering your existing Academy ID, please use the Reset password feature on the Profile system.

If you do not have an Academy ID, please register on our Academy Profile system to create one.
Home address
Street Address City ZIP / Postal Code Country
Home Region(Required)

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
Hidden section that is only shown when the organisation is unknown
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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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Does this organisation provide any NHS-funded care?(Required)

Yes

No

Don’t know
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Please note that you will find the majority of job titles available by selecting the admin and clerical option from the drop down list. If however you do not find your job title listed, please select ‘other’ and type in your FULL job title.
Role(Required)
Area of work(Required)
Job Title(Required)
Please enter your job title
Salary/Band(Required)
Current?(Required)

Yes

No
Are you currently active in this role? Please note: we only require past roles if you are unemployed.
If you answered no to the above question, please enter your last active role:
What organisation was that role in?(Required)
Date of last employment:(Required)
DD slash MM slash YYYY

Equality & Diversity
We are committed to promoting equality of opportunity, by developing and retaining a diverse workforce that reflects our diverse communities. To help us achieve our Equality, Diversity and Inclusion (EDI) ambitions, we collect, monitor and analyse diversity data about participants who access leadership development opportunities to identify how well we are doing and remove barriers to awareness and access. We need your help and cooperation to enable us to do this by filling in this form. This data is kept confidential. In line with the Equality Act 2010, positive action is taken when required to help us achieve our EDI ambitions. To find out more about our EDI ambitions/how your data is used please contact us via [email protected].
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)
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
What was the occupation of your main household earner when you were about aged 14?(Required)
Social Mobility Commission (SMC) research shows that people from lower socio-economic backgrounds may face a ‘progression gap’. The SMC regard this question as the best measure we have to assess someone’s socio-economic background and is applicable to those of all ages and from all countries, see Cross-industry toolkit – Social Mobility Commission. This will enable us to make opportunities for applications to our programmes equitable for people from lower socio-economic backgrounds and work towards better representation (at Board level) of the communities we serve. Your data will be stored and handled in line with GDPR best practice, be used in aggregate to help make evidence-based decisions and will not be used for appointment and promotion decisions.
Age(Required)

Privacy Agreement

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

About you

Employment Information

New Organisation

Equality & Diversity

Your Files:

How to apply

Keeping in touch

Terms and Conditions

Summary