APPENDIX 3 RELEVANT INFORMATION DECLARATION – Any appointee to a Public Body 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 to any of the “yes” following questions. Have you: Yes No ever been convicted of any offence (other than minor motoring offences) which are not spent in accordance with the Rehabilitation of Offenders Act 1974; got any charges outstanding; become bankrupt over the past 10 years; been dismissed from any office or employment over the past 10 years; ever been disqualified from either acting as a Company Director or in the management of a Company; ever been a Director, Partner or Manager of a Company has gone into liquidation, receivership or administration; 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) 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. Name: …………………………………………………………………. Signed: ………………………………………………………………… Date: …………………
APPENDIX 3 RELEVANT INFORMATION – DECLARATION Any appointee to a Public Body 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 ever been convicted of any offence (other than minor motoring offences) which are not spent in accordance with the Rehabilitation of Offenders Act 1974; got any charges outstanding; become bankrupt over the past 10 years; been dismissed from any office or employment over the past 10 years; ever been disqualified from either acting as a Company Director or in the management of a Company; ever been a Director, Partner or Manager of a Company has gone into liquidation, receivership or administration; 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) 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. Name: …………………………………………………………………. Signed: ………………………………………………………………… Date: …………………