First Name:

Surname:

Address:

Home Tel No:

Mobile Tel No:

Email:

Please tell us why you are interested and feel you would be suitable to become a member of the Interview Panel. (Please note: your Neighbourhood Manager will be consulted as part of the decision-making process for recruiting members to the panel.)

Are you related to an employee of the First Wessex Housing Group? (including Atlantic Housing Limited, Pavilion Housing Association, Portsmouth Housing association, First Atlantic Housing Limited, Fernhill Care and Wessex Property Services)
Yes		No

Please give details

Do you have any other interests to declare, for example, a business relationship with any person or firm that is associated with the group, which could conflict with any appointment made to you by the First Wessex Housing Group?
Yes		No

Please give details

Thank you for completing this application form and for the interest you have shown in becoming involved. We will be in contact with you shortly to discuss your application.