CITIZEN LED INSPECTION |APPLICATION

APPLICATION FORM

PERSONAL DETAILS

Please provide the following information:

Name:
Address:
Town:
Postcode:
Day Time Telephone:
Mobile Telephone:
Email:

ABOUT YOU

Please answer the following questions:

WHAT INTERESTS YOU IN UNDERTAKING THIS ROLE?
(Maximum of 100 words)

ABOUT YOU(continued)

Please answer the following questions:

ARE YOU AVAILABLE AND WILLING TO ATTEND INSPECTIONS AT DIFFERENT LOCATIONS THROUGHOUT THE WEST LOTHIAN AREA?
TRAVEL EXPENSES WILL BE PAID.()
Yes / No
WHEN WOULD YOU BE AVAILABLE TO CARRY OUT INSPECTION ACTIVITY (INCLUDING TRAINING AND INSPECTION DAYS) DURING THE WEEK? ()
Daytime: / Evening:
Both: / Neither:
WHEN WOULD YOU BE AVAILABLE TO CARRY OUT INSPECTION ACTIVITY (INCLUDING TRAINING AND INSPECTION DAYS) DURING THE WEEKEND? ()
Daytime: / Evening:
Both: / Neither:
IF CHOSEN WHAT SERVICE WOULD YOU PREFER TO INSPECT?()
Planning: / Procurement:

Please confirm:

ARE YOU AGED OVER 16 YEARS?()
Yes: / No:
DO YOU LIVE IN WEST LOTHIAN?()
Yes: / No:

YOUR EXPERIENCE

Please answer the following question using the INSPECTORSPECIFICATION:

WHAT SKILLS AND ABILITIES DO YOU HAVE THAT WOULD MAKE YOU A GOOD CITIZEN INSPECTORS?
(Maximum of 200 words)

EQUALITY MONITORING QUESTIONNAIRE

Please () or write in the boxes, as appropriate.

AGE()

Date of Birth:

GENDER()

Male: / Female:

ETHNIC GROUP()

  1. WHITE

Scottish: / Welsh:
English: / Northern Irish:
British: / Irish:
Gypsy / Traveller: / Polish:
Any other White ethnic group(please specify):
  1. MIXED OR MULTIPLE ETHNIC GROUPS

Any other Mixed background (please specify):
  1. ASIAN, ASIAN SCOTTISH OR ASIAN BRITISH

Pakistani, Pakistani Scottish or Pakistani British: / Indian, Indian Scottish or Indian British:
Bangladeshi, Bangladeshi Scottish or Bangladeshi British: / Chinese, Chinese Scottish or Chinese British:
Other (please specify):
  1. AFRICAN, CARIBBEAN OR BLACK

African, African Scottish or African British: / Caribbean, Caribbean Scottish or Caribbean British:
Black, Black Scottish or Black British:
Other (please specify):
  1. OTHER ETHNIC GROUPS

Arab, Arab Scottish or Arab British:
Other (please specify):
  1. OTHER ETHNIC GROUPS

Any other (please specify):

DISABILITY()

DO YOU HAVE ANY OF THE FOLLOWING CONDITIONS WHICH HAVE LASTED, OR ARE EXPECTED TO LAST, AT LEAST 12 MONTHS?
Deafness or partial hearing loss: / Blindness or partial sight loss:
A learning disability: / A learning difficult or developmental disorder:
A mental health condition: / A long-term illness, disease or condition:
Physical disability: / No disability:

SEXUAL ORIENTATION()

Bi-sexual: / Gay man:
Gay woman/lesbian: / Heterosexual/straight:
Other: / Prefer not to say:

RELIGION OR BELIEF()

Buddhist: / Church of Scotland:
Hindu: / Jewish:
Muslim: / No religion:
Other Christian: / Pagan:
Roman Catholic: / Sikh:
Other: / Prefer not to say:

CARING RESPONSIBILITIES()

DO YOU HAVE CARING RESPONSIBILITIES FOR A CHILD OR CHILDREN OR ANYONE ELSE (E.G. A FAMILY MEMBER, FRIEND, NEIGHBOUR, ETC)? (all that apply)
Adult dependant: / Any other dependants under 18:
Adult dependant with a disability: / None:
Children under 18 with a disability: / Prefer not to say:
Children under 16:

DATA PROTECTION OF PERSONAL INFORMATION()

Personal information which you supply to West Lothian Council may be used in a number of ways, for example:

  • To process your application
  • For fraud prevention
  • For statistical reporting
  • Name as part of any CLI reports, displayed on the councils website, which you have been involved in.

We will not disclose your information to anyone outside West Lothian Council except to help prevent fraud, or if required to do so by law.

We will keep your information as long as you are a member of the Citizen Led Inspection Programme.

If you are not happy about how we use your information, you have the right to complain to the Council’s Data Protection Officer and to the Information Commissioner. Details of which can we found of the Council’s Website –

Please tick () to acknowledge you have read and understood the Data Protection Statement above:

PLEASE RETURN THE COMPLETED FORMS

Return your completed form by email to:

Or by post to: CITIZEN LED INSPECTION TEAM | WEST LOTHIAN CIVIC CENTRE | HOWDEN SOUTH ROAD | LIVINGSTON | EH54 6FF