PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Office Use Only
Candidate URN: / PS
Tier 2:
Tier 3:

Police Staff Application Form

You should download and refer to the following documents before completion:

  • the Application Guidance Notes;
  • the Job Profile;
  • the Equal Opportunities Monitoring form.

Post applied for:
Reference number:
Location of post:
DATA PROTECTION
The information you provide in this application form will be entered into a manual filing system and onto a computerised recruitment system and as such is covered by the rules set out by Data Protection legislation.
1. Personal Details
Title: / Surname/family name(s):
(Mr, Ms, Mrs, Miss, Dr) / Forename(s):
Previous family name(s): / Previous forename(s):
Place of birth: / National Insurance No:
Date of birth: / Nationality:
Non-UK British Citizens: Is your stay in the UK free of restrictions?-select-YesNo
You must include a copy of your passport which shows that your
stay in the UK is free of restrictions. Photocopy of passport included?-select-YesNo
If no, please state why not:
2. Contact Details
Current full
postal address: / Address line 1:
Town/city:
County:
Postcode:
Please provide an email address for us to correspond with you about your application:
Email address:
How long have you been residing at the above address? / year(s) and month(s)
Telephone numbers (including area code)
Home:
Work:
Mobile: / May we contact you at:
-select-YesNo
-select-YesNo
-select-YesNo
3. Relationships
If you are related to, or have a close personal relationship/friendship with anyone working for Warwickshire Police/West Mercia Police, please state their name, status within the organisation and relationship to you:
Name / Status / Relationship

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
4. Qualifications and Training
Qualification(s) / Grade(s) / Date obtained
Relevant professional and training courses attended:
5. Current Membership of Professional Organisations (including level if appropriate)

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
6. Driving Qualifications
Do you hold a current, valid full UK driving licence?-select-YesNo
7. Employment and Education History
References will be requested for the last three years or previous two employers (whichever is longer). Include any educational establishments that you have been a student of during this period, or explanations for any gaps in your employment history.
Current or most recent employer
Current/organisation name:
Post held:
Salary: / Start date: / End date: / Period of notice:
(if applicable)
MM/YYYY / MM/YYYY

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Current/most recent duties and responsibilities:

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Contact for reference purposes:
Do you wish to be consulted before this referee is approached? / -select-YesNo
Address:
Town/city:
County: / Postcode:
Email: / Tel no:
Reason for leaving:
Previous employment (most recent first)
Organisation name:
Post held:
Salary: / Start date: / End date: / Reason for leaving:
MM/YYYY / MM/YYYY

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Duties and responsibilities:

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Contact for reference purposes:
Address:
Town/city:
County: / Postcode:
Email: / Tel no:
Organisation name:
Post held:
Salary: / Start date: / End date: / Reason for leaving:
MM/YYYY / MM/YYYY

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Duties and responsibilities:

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
Contact for reference purposes:
Address:
Town/city:
County: / Postcode:
Email: / Tel no:
Organisation name / Post title / Start date / End date / Reason for leaving
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
8. Evidence in support of your application
A maximum of two pages typed in Arial font size 12 will be considered, any additional text will be disregarded (please refer to Guidance Notes).

PROTECT - PERSONAL (when completed)

PROTECT - PERSONAL (when completed)

Rev 12/14
Page 1 of 5 / Office Use Only
Candidate URN: / PS
9. Cautions and Convictions
Please refer to guidance notes and provide relevant details below:
Please tick here if not applicable:
10. Declaration
  • I am eligible to apply and have checked my own eligibility against the criteria in the Guidance Notes.
  • Any offer of appointment will be subject to the receipt of satisfactory references and pre-employment recruitment vetting checks and may be subject to a medical examination.
  • If any information provided is found to be untrue or is found to have been deliberately withheld, this will result in any offer of employment being withdrawn or the initiation of misconduct proceedings which may result in any contract of employment being terminated.
  • Canvassing directly or indirectly may disqualify me from the appointment.
  • I must inform the HR Service Centre (Recruitment) without delay of any change in my circumstances.
The Chief Constable retains the right to reject any application without giving reasons.
By ticking this box, I declare that I have read and agree to the above conditions:
Name: / Date of application:

Please return your completed application form, together with the Equal Opportunities Monitoring form, by the closing date specified in the advertisement to:

PROTECT - PERSONAL (when completed)