(CASUAL VACANY)

Lydney Town Council

Council Chambers, Claremont House, High Street, Lydney, Glos, GL15 5DX Telephone: 01594 842234

Email: town.clerk@lydneytowncouncil.gov.uk Web. www.lydneytowncouncil.gov.uk
APPLICATION FORM FOR THE ROLE OF TOWN COUNCILLOR (Casual Vacancy)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postcode
Telephone Number
Mobile Number
Please enter a valid phone number.
Email
example@example.com
It is a condition of being a Town Councillor that your official email address supplied by the council be made public.

LEGAL QUALIFICATIONS FOR BEING A PARISH COUNCILLOR

To qualify you must be able to answer 'Yes' to both questions below
Are you a British Citizen, a Commonwealth Citizen or Citizen of a European Union county?

YesNo
Are you aged 18 or over?

YesNo
To qualify you must be able to answer 'Yes' to at least one of the questions below
Are you on the Electoral Role for Lydney?

YesNo
Have you been the owner or tenant of land in Lydney for at least a year?

YesNo
Have you lived in Lydney or within 3 miles of its boundary, for at least a year?

YesNo
Have you had your only or main place of work in Lydney for at least a year?

YesNo
DISQUALIFICATIONS
Are you the subject of a bankruptcy restrictions order or interim order?

YesNo
Have you within the last five years been convicted of an office in the UK, the Channel Islands or the Isle of Man, which resulted in a sentence of imprisonment (whether suspended or not) for a period of three months or more without the option of a fine?

YesNo
Are you disqualified by order of a court from being a member of a local authority?

YesNo
Please briefly outline as to why you are interested in being a Town Councillor
Please tell us something about the life experiences you will bring to Lydney Town Council, for example previous local government experience, work with the voluntary or community sector, business or trade union experience, youth-based activities etc.
Signed

Clear
Date

MonthDayYear
Date
Should be Empty:

APPLICATION FORM FOR THE ROLE OF TOWN COUNCILLOR (Casual Vacancy)

DISQUALIFICATIONS