For office use only: Application Number………………

/ APPLICATION FOR MEMBERSHIP OF GLOUCESTERSHIRE LOCAL ACCESS FORUM

Committed to Equal Opportunities

PLEASE COMPLETE ALL SECTIONS IN BLACK INK (Use a separate sheet if insufficient space)

To enable the appointing authority to comply with section 4 of the Local Access Forums (England) Regulations 2007, applicants are requested to indicate the field of interest they represent.
The members shall be persons who appear to the appointing authority to be representative of -
(a) users of local rights of way or the right conferred by section 2(1) of the CROW Act 2000 (rights of public in relation to access land);
(b) owners and occupiers of access land or land over which local rights of way subsist; or
(c) any other interests especially relevant to the authority’s area.
[1]Please state the principal field of interest that you represent (i.e. a, b or c) and the justification for your choice. ______
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[2] What other fields of interest do you have that are relevant to this application?
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[3]Please give details of activities that you have been involved with which have had a positive impact on improving access to land or public rights of way in Gloucestershire.
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[4]What do you consider to be the most important aspects of the Countryside and Rights of Way Act 2000 and associated legislation? In addition what concerns, if any, do you have about the Act?
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[5]What skills can you bring to the Gloucestershire Local Access Forum to help it carry out its work?
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[6] Is there any other information you would like to add in support of your application?
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The chairman and vice-chairman of a local access forum shall be appointed by the members of the forum. Please indicate below if you are prepared to be considered as chairman or vice-chairman.

I am prepared to stand as chairman/vice chairman of the Local Access Forum YES/NO*

YOUR DETAILS

Name______

Address______

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Telephone number______

E mail address______

Alternative phone number ______

REFERENCES

Please give details of two referees. Your referees must have knowledge of your work and character. Both referees should ideally be senior people in their organisation. In the case of applicants leaving full time education or not having worked since doing so, the Head of School, College or University should be one of the named referees. We do not accept references from friends or familymembers. To ensure we process your application in a speedy and efficient way, we prefer to contact your referees by e-mail. Could you therefore provide us with full details of your referee’s e-mail address.

Your references should not include officers or members of the County Council.

If you are invited for interview may we approach your referees without further reference to you? Yes/No

For office use only: Application Number………………

  1. Name:______Position:______Address:______Telephone:______

E mail______
Name:______
Address:______Telephone:______
E Mail ______

For office use only: Application Number………………

In what capacity do you know the above?In what capacity do you know the above?

Please note:-

(i)Deliberate omission or falsification of information could lead to disqualification of your application.

(ii)Canvassing of Council Members or Officers, directly or indirectly, will disqualify your application.

(iii)If your application is successful, some of the information you give will be used to compile a membership file and will be stored in a computer

(iv)Membership of Gloucestershire Local Access Forum does not constitute employment status with Gloucestershire County Council.

Declaration

I certify that the information given by me on this application form is true to the best of my knowledge and I understand that if I am appointed to a Local Access Forum and such information is found to be materially incorrect, my membership may be terminated.

Signature:______Date:

Please return this form along with the accompanying sheet to: PROW, Gloucestershire County Council, Shire Hall, Gloucester, GL1 2TH

Equal Opportunities

The County Council is committed to having a Local Access Forum that reflects the diverse make up of the communities in Gloucestershire. To help us achieve this objective, applicants are asked to provide particular information so that we have an accurate picture of our Forum. The information will also allow us to monitor our appointment practices, to ensure that we do not unlawfully discriminate and help us to develop inclusive policies.

Please complete this part of the application form so that we can check whether we are, in fact, receiving applications from all sections of the community, that candidates receive fair and equal treatment at all stages and that we comply with the relevant legislation.

This monitoring form will be separated from the rest of the application form immediately on receipt and before the selection of candidates for interview takes place. The information you give is confidentially managed and does not affect your application. It will greatly assist us if you provide as much information as possible, but you are not obliged to do so.

What is your ethnic group?
 Choose one section from (a) to (e) then tick the appropriate box to indicate your cultural background:
(a)White
British
Irish
Any other White background
please write in below / (b)Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
please write in below / (c)Asian or Asian British Indian
Pakistani
Bangladeshi
Any other Asian background
Please write in below
(d)Black or Black British
Caribbean
African
Any other Black background
Please write in below / (e) Chinese or Other ethnic Chinese
Any other
Please write in below / Would rather not state

Which of the following best describes your religion/belief?
BuddhistChristianHinduJewishMuslimSikh Humanist Atheist

None Other (please specify) Would rather not state

Which of the following best describes your sexual orientation?
Heterosexual / Gay / Lesbian / Bisexual / Would rathernot say
Which of the following best describes your gender?
Male / Female
Transgender

Is your gender identity the same as the gender at birth? Yes No

Date of Birth / / Age
Data Protection

The information supplied on this form is being collected as part of the Council’s recruitment and selection procedures for a Local Access Forum. If you are successful with your application the information will also be used for the determination and payment of salary and to produce a Statement of Particulars. When you complete this form you are giving your consent to the Council to hold and use personal information for these purposes. The information you provide may also be disclosed to relevant statutory bodies. The application forms of unsuccessful candidates will be retained for six months, after which time they will be destroyed.