Appointment of an Independent Member of the Standards Committee

Confidential

Surname:

Forenames:

Title:

Telephone (Work):

Telephone (Home):

E-mail:

Address




County
Postcode

Occupation (Former occupation if retired)

Professional Qualifications:

References

Please give names and addresses of two persons the Council may contact for confirmation of your suitability for such an appointment:

Name ^*

Address




County
Postcode

Name ^*

Address




County
Postcode

Please set out below why you wish to be considered for this appointment, what qualities and experience you feel you will bring to the post and why it interests you.

(Details to include your reasons for interest in promoting high standards in local government/ details of any experience in promoting and or supporting high standards of conduct/ details of experience which reflects your analytical ability to read reports and assess issues of conduct)

Please give details of your previous or existing voluntary/public services experience

Declarations

I confirm that: ^*

I have not within the past five years been a member or officer of Spelthorne Borough Council
I am not a relative or close friend of any member or officer of Spelthorne Borough Council
I am not a member or officer of any other local authority
I have no criminal convictions or been sentenced to a term of imprisonment for a period of not less than three months in the past five years.
I am not subject of a bankruptcy restriction order or interim order.
I understand that the Council has the right to reject any application if
incorrect information is given

Date:

Signature:

If returning by e-mail you do not need to sign the form