ࡱ> a bjbjZZ ;^0i0i~5xx [ [ [ o o o 8 4 o !!!!!)$)$)$/111111<j1[ )$#^)$)$)$1 !!F&&&)$X 8![ !/&)$/&&b 1 C !Жsy$jG\0\$\8\[ ;)$)$&)$)$)$)$)$11%)$)$)$)$)$)$)$\)$)$)$)$)$)$)$)$)$xY : COMPLAINT FORM MEMBER(S) CONDUCT Please provide us with your name and contact details: Date Submitted:TitleFirst name:Last name:Address: Daytime telephoneEvening telephoneEmail address Your address and contact details will not usually be released unless necessary or to deal with your complaint. However, we will tell the following people that you have made this complaint: The Member you are complaining about The Monitoring Officer or the authority The councils Independent Person (if required) Members of the Hearings Panel if convened to consider your complaint Officers involved in mediation (if applicable) We will tell them your name and give them a summary of your complaint. We will give them full details of your complaint where necessary or appropriate to be able to deal with it. If you have serious concerns about your name and a summary, or details of your complaint being released, please complete section 5 of this form. Please tell us which complainant type best describes you: Member of the public An elected co-opted Member of an authority, including district, town and parish councillor Member of Parliament Local authority monitoring officer Other council officer or authority employee Other (please state) Making your complaint Once your complaint has been received a decision will be taken in accordance with the councils published arrangements as to what action, if any, should be taken on it. You will not have the opportunity to attend a meeting at this stage. It is important that you provide information that you want taken into account as part of your complaint. Please refer to the councils published arrangements under the heading Making a complaint which explains how your complaint will be dealt with. Please provide us with the name of the member(s) you believe have breached the Code of Conduct. TitleFirst nameLast nameParagraph of the Code of Conduct believed to have been breached    It is important that you provide a summary of the information you wish to have taken into account (within the space provided) so a decision can be made, in accordance with the published arrangements, whether to take any action on your complaint. For example: You should be specific, wherever possible, about exactly what you are alleging the member said or did. For instance, instead of writing that the member insulted you, you should say what it was they said. You should provide the dates of the alleged incidents wherever possible. If you cannot provide exact dates it is important to give a general timeframe. You should confirm whether there are any witness to the alleged conduct and provide their names and contact details if possible. You should provide any relevant background information. Interests. Tick this box if you believe that the Member(s) either did not declare an interest, or has declared the wrong type of interest. If you are unsure, please tick the box, adding an explanation in section 4. Please explain in this section what the Member has done that you believe breaches the Code of Conduct. Please enclose any supporting documents but limit these to those that are directly relevant and material to the complaint. If you are complaining about more than one Member you should clearly explain what each individual Member has done that you believe breaches the Code of Conduct. Please provide us with details of your complaint (within the space provided) Please explain what steps, if any, have you taken to resolve this complaint directly with the Member concerned? Would you be prepared to engage in mediation with the member concerned, if considered appropriate, to try and resolve the complaint? Yes No Is there a particular remedy that you seek from the member, such as an apology?  Mediation is a way of resolving disputes with the assistance of an independent mediator who will try and help the parties reach a solution to the dispute that both parties are agreeable to. The independent mediator will avoid taking sides, making judgements or giving guidance. They are simply responsible for developing effective communications between the parties with a view to a common sense settlement being arrived at. Mediation is a voluntary process and will only take place if the parties agree and remains confidential to the parties involved. Only complete this next section if you are requesting that your identity is kept confidential. In the interests of fairness and natural justice, we believe members who are complained about having a right to know who has made the complaint. We also believe that they have a right to be provided with a summary of the complaint. Please note that requests for confidentiality will only be granted exceptionally. If your request for confidentiality is not granted, you will be given the opportunity to consider whether you wish to proceed with your complaint on the basis that your identity is not kept confidential. Further information on this can be found in the Councils published Arrangements. However, it is important to understand that in certain exceptional circumstances where the matter complained about is very serious, we can proceed with an investigation or other action and disclose your name even if you have expressly asked us not to. Please provide us with details of why you believe we should withhold your name and/or the details of your complaint:  Additional Help Complaints must be submitted in writing. This includes electronic submissions. However, in line with the requirements of the Disability Discrimination Act 2000, we can make reasonable adjustments to assist you if you have a disability that prevents you from making your complaint in writing. Please contact The Head of Democratic Services on 01522 552840 who can offer you support and services through which to make your complaint.     PAGE  If you answered no, please state reason why below: #$%[\lmntuvI J   I J X Y ʺʺʺʺʺʺʺʺޕޕޕޕޕh%Vh[KHOJQJ\^J h%Vh[hjh[OJQJ\^Jhjh[KHOJQJ\^J'hjh[5CJKHOJQJ^JaJh[KHOJQJ\^J'h.h[5CJKHOJQJ^JaJ:#$%[\lm$$Ifa$gd}1$ & F_a$gd[ $a$gd[ $a$gd[mntuvff$$Ifa$gd}1kd$$Ifl0 #.  t0644 lapyt}1uvvff$$Ifa$gd}1kd$$Ifl0 #.  t0644 lapyt}1vff$$Ifa$gd}1kdF$$Ifl0 #.  t0644 lapyt}1vffffff$$Ifa$gd}1kd$$Ifl0 #.  t0644 lapyt}1vff$$Ifa$gd}1kd$$Ifl0 #.  t0644 lapyt}1vff$$Ifa$gd}1kd/$$Ifl0 #.  t0644 lapyt}1vff$$Ifa$gd}1kd$$Ifl0 #.  t0644 lapyt}1I J vj]MA dgd[hd^hgd[ h^hgd[ $a$gd[kdu$$Ifl/0 #.  t0644 lapyt}1J  J Y $a$gd[$hd^ha$gd[$da$gd[hd^`hgd[ & Fbdgd[hd`hgd[   ( ) ! 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