Author: avydulinska
Last saved by: Paul Windley (NELC)
Company: Greater London Authority

Application Form

Independent Person
North East Lincolnshire Council

Before completing this form please read the enclosed information sheet, including the information set out regarding general disqualifications applying to this post.

Please provide a copy of your CV and complete the following details:

SURNAME…………………………………………………………………………
(Please use capitals)

FORENAME/S ……..……………………………………………………………..

TITLE: (Mr/Mrs/Miss/Ms or other - please specify)………………………………..

HOME ADDRESS:………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

TELEPHONE: Home ……………………  Work/business …………………………….

EMAIL  ……………………………………………………………………………..

Please give details of your current/recent employment and any relevant voluntary work:

Please describe how your skills and/or experience demonstrate that you meet the criteria set out below.

1.	A keen interest in and understanding of standards and propriety within public life

2.	Awareness of the Standards regime 

3.	Understanding or experience of working with or serving on public bodies, and the role of elected representatives and evidence of the ability to apply this to practical situations and give advice

	
4.	High standards of personal integrity

5.	Ability to question, think logically and evaluate information

6.	Ability to be objective, independent and impartial

Please provide details of two people we may contact for references.  References will be taken up if you are invited for an interview:

1.  Name:	…………………………………                          

Address:	…………………………………..
		…………………………………..
		…………………………………..
		…………………………………..
		…………………………………..

Telephone number:	…………………………...

2.  Name:	…………………………………                          

Address:	…………………………………..
		…………………………………..
		…………………………………..
		…………………………………..
		…………………………………..

Telephone number:	…………………………...

Signed……………………………………………        Date…………………

Please return this form (and your CV) and the Declaration Form to:

Mrs Eve Richardson-Smith
Deputy Monitoring Officer
Municipal Offices
Town Hall Square
Grimsby
North East Lincolnshire 
DN31 1 HU

Closing date: noon 
Interview Dates:  Interviews are likely to take place in week commencing