Councillor - Co-option Application

1
Putting yourself forward to be Co-opted on to Clydach Community Council means that a vacancy has arisen within the Council and there has not been the required numbers interested following a period where the vacancy occured. There will not be an election to fill this vacancy as it will be decided by the existing members of the council using this application form.

Please make sure you have read what will be required of you as a Community Councillor before completing this form. This is available at: https://clydach.wales/public-documents
2
Name
First Name
Last Name
3
Application to the ward of (Clydach, Vardre, Graigfelen or Glais):
4
Address
Street Address
Street Address Line 2
Town
County
Post Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Email
example@example.com
6
Phone Number
Area Code
Phone Number
7
Are you over 18?You must be over 18 to be a Community Councillor
YESNO
8
Which of the following apply to you?
Registered as an elector within the parish of Clydach
I have, during the whole of the 12 months preceding the day of this application been an owner or tenant of land or other premises in the parish of Clydach
My principal or only place of work during those 12 months has been in the parish of Clydach
I have during the whole of those 12 months resided in that parish of Clydach named above or within 4.8 kilometres of it. (3 miles)
9
Have you read the requirements of being a Councillor?This is available from our website at https://clydach.wales/public-documents
YESNO
10
Can you commit to attend committee and full council meetings as well as training sessions as required?
YESNO
11
Do you understand that any interests you may have, including any political affiliation will be made public if you are appointed?
YESNO
12
Check any of the following statements that may apply to you.
I am employed by the Community Council
I am the subject of a Bankruptcy order or interim order
I have been sentenced to a term of imprisonment of three months or more (including a suspended sentence), without the option of a fine, during the five years before the date of this application
I have been disqualified under the Representation of the People Act 1983 (which covers corrupt or illegal electoral practices and offences relating to donations). The disqualification for an illegal practice begins from the date the person has been reported guilty by an election court or convicted and lasts for three years. The disqualification for a corrupt practice begins from the date a person has been reported guilty by an election court or convicted and lasts for five years.
I have been disqualified from standing for election to a local authority following a decision of the First-tier Tribunal (formerly the Adjudication Panel for England) or the Adjudication Panel for Wales.
13
Which (if any) of the following skills do you have?These are not essential. You will have the option to expand in the next question.
Event Management
Community Planning
Financial Management
Media / Advertising
Committee Chairing
Local Government Administration
Legal Experience
Other
14
Expand on your skillsPlease use the text box below to expand on any skills you have identified above, or to tell us about other skills not listed. Bullet points will also be accepted. These skills should be related to the role of Councillor. (Max 500 words)
0/500
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Ok
15
What is important to you?This is in the context of community life within Clydach.
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Ok
Ok
16
Thinking about what is important to you, what would you do as a Councillor to help promote / improve on the things you have identified?
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Ok
Ok
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