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for the Labour Party to monitor the success of its local government candidate selection process. Please complete this form and return it with your completed nomination form. Name: _______________________________________ Gender Age Male 18-29 30-39 Female 40-49 50-59 60-69 70+
Ethnic Background I would describe myself as (please circle one): Indian White - British Pakistani White – Irish Bangladeshi Any other White Background (specify ) Background (specify) Mixed – White & Black Caribbean Caribbean Mixed – White & Black African British – African Mixed – White & Asian Background (specify) Any other Mixed Background (specify) group (specify) Chinese or other ethnic Any other Black Black or Black Black or Black British – Any other Asian Asian or Asian British – Asian or Asian British – Asian or Asian British –
Other (specify) _______________________________________________________________ Disability Do you consider yourself to have a disability? Yes No
If yes, what additional support, if any, do you require? ___________________________________________________________________________________ ___________________________________________________________________________________ Employment Status (please circle one) Employed (f/t) (f/t) Labour Party Membership How long have you been a party member? <1year* 1-5 years 6-10 years 11-20 years >20 years Employed (p/t) Unemployed Retired Student
*Only in exceptional circumstances, as decided by the Local Campaign Forum/Party, will members with less than one year’s party membership be allowed to stand as candidates.
Trade union membership How long have you been a member of a trade union? <1year 1-5 years 6-10 years 11-20 years >20 years
Experience of public office or candidature 1 I have previously been a candidate I have previously been an elected member I am currently an elected member 2 3 4 5
1 – Local = town, parish or community council 2 – District = District council in UK 3 – County = county council in England/ Wales or Scottish regional council 4 – Unitary = unitary authority, metropolitan or London borough 5 – Parliament = UK or European