Application form for Chair and Non-Executive Director Pool

Please Note: NHS IMAS will consider every application to join the Interim Chair and Non-Executive Director Pool although not every applicant will be registered. If you have not heard from us within 28 days your application will not have been successful and your information will not be stored by NHS IMAS.

If successful and by agreeing to be on the register, you will agree to NHS IMAS sharing the information on this form, including your CV and references with other NHS organisations for consideration for potential assignments. You have the right to request to remove your details from the NHS IMAS register at any point and withdraw your consent to share your information by contacting us on

1. Personal Details
2. Previous NHS Employment
Please note that as a condition of registering with NHS IMAS you consent to NHS IMAS sharing this information with potential clients.
3. Relevant recent experience, knowledge and expertise
Please provide evidence of your experience, knowledge and expertise in the following areas as they apply to the interim Chair and Non-Executive Director Criteria attached (no more than 250 words for each):
4. Specialties
5. Availability /Mobility
6. Supporting references
Please provide the names and contact details (including email addresses) of four referees. All work undertaken within the past twelve months must be covered. At least three of the referees should be Executive Director level (substantively employed within the NHS), for whom you have undertaken work.
Please note we cannot accept a reference from someone you have already provided a reference for to join the NHS IMAS pool.
We will contact your referees direct in order to complete the registration process.
Referee 1
Referee 2
Referee 3
Referee 4
7. Compliance with IR 35
When on assignment you may be asked by the client organisation to confirm that you are IR 35 compliant. It is important that you understand this and are able to confirm that you are IR 35 compliant. Further information can be found on the HMRC website at
Guidance can be found on

Please note currently arms lengths bodies cannot contract with sole traders.
8. Professional Standards
NHS IMAS is committed to the professional standards for members of NHS Boards and CCG governing bodies. By registering with NHS IMAS you agree to being committed to these standards – professional standards.
9. CV
Being a pool member with NHS IMAS does not guarantee that you will be found work or that you will be placed on an assignment. Our service is demand led and we do not send out pool members CVs speculatively to the NHS.