Form 2 - Declaration

Any appointee could find that matters or incidents which previously attracted no attention could become matters of public interest once the person concerned holds a public appointment.

Please provide details on a separate sheet if you answer “yes” to any of the following questions.

Have you:	YES	NO
(1)	ever been convicted of any offence (other than minor motoring
offences)which are not spent in accordance with the Rehabilitation
of Offenders Act 1974;
(2)	any criminal charges outstanding;
(3)	been declared bankrupt in the past 10 years;
(4)	been dismissed from any office or employment over the past 10 years;
(5)	ever been disqualified from either acting as a Company Director or
in the management of a Company;
(6)	ever been a Director, Partner or Manager of a Company which has
gone into liquidation, receivership or administration;
(7)	any other information which you would consider relevant to an
assessment of your suitability as a public appointee; for example
business interests or personal relationships, which may lead to an
allegation of conflict of interest.

Please note: a YES answer to any of the questions (1) to (7) above will not necessarily disqualify a candidate for public appointment.

Each case will be treated on its merits.

However, failure to disclose relevant information may result in an appointment being summarily terminated. Any potential conflicts of interest detailed here may, if appropriate, be explored with you during any interview to establish how you would address the issue(s) should you be successful in your application.

Your Name:	Date: