Testing page Lifeline opt out form - testing: Your contact information First name * Last name * Address * Postcode * Preferred contact number * Email address * Your decisions Opting out * I no longer wish to continue with the Lifeline service. Lifeline charges * I understand that the charges will be removed from my account with effect from Sunday, 8 October and this means that the service will no longer be active. Equipment collection * I have lifeline equipment that needs to be collected I don't have lifeline equipment that needs to be collected Consent for storing submitted data * Yes, I give permission to store and process my data No, I don't consent to storing and processing my data Title * Dr Mr Mrs Miss Ms Other Other title * Please provide your preferred title First name * Surname * Preferred name Address * Postcode * Email address * Contact number * How many years have you been one of our customers? * Why would you like to become a member of the Scrutiny Team? * Behaviours and skills * Please select three of the following key behaviours and skills which you believe are your strongest qualities. These are desirable for new members of the Scrutiny Team. Active listening Analysing information Applying relevant knowledge Building lasting relationships with others Good communication skills Good ICT skills Good organisational skills Identifying continuous improvement in services Leadership and motivation Presentation skills Questioning Teamworking Experience and knowledge * Based on the person specification for this role, what knowledge and experience do you have that will make you an excellent Scrutiny Team member? Relevant experience/qualifications Please provide details of relevant employment, community and/or voluntary experience and qualifications that you have which you believe will benefit the Scrutiny Team. Are you related to, or known by, any of our staff members, Directors or Board Members? * Yes No Please provide more details * Are you a Board Member or staff member of another housing provider? * Yes No Please provide more information * Consent for storing submitted data * The information which you’ve given us will be processed and held securely. It'll only be used for recruitment and selection purposes. Yes, I give permission to store and process my data No, I don't consent to storing and processing my data Declaration * I confirm that to the best of my knowledge the information contained on this form submission is accurate. Help us to fight spam emails Please tick the box below and follow the instructions to help us fight spam emails.