/ SECURITY VETTING FORM
(including RV, NPPV Level 2 & 3)
PLEASE READ AND SIGN THAT YOU UNDERSTAND THE FOLLOWING
IT IS IMPORTANT!
Confidential security vetting checks are carried out on all applicants for posts working for or with Police Forces in the East Midlands. The checks comply with the standards laid out by Association of Chief Police Officers National Vetting Policy and Home Office guidelines to determine whether the candidate represents a risk to the assets of the Force or the Police Service as a whole.
The information required in this questionnaire is to allow the Chief Constable to fulfil a statutory obligation to run an efficient and effective Force. To meet this obligation he/she must ensure the safety of staff, and that those who have access to Force information are trustworthy, and unlikely to breach confidence.
We will carry out checks on you on national Police computer systems, local Force systems and requests checks from any Forces which cover any addresses quoted in this application. We will want to know whether you or any close family or associates are involved in criminal or other anti-social activity and we will therefore search for any criminal convictions, cautions, fixed penalty notices (of any kind), pending criminal proceedings, or intelligence recorded against you or anyone in your family. We will also carry out financial (eg credit reference) checks on you, any persons living with you and on any addresses which you may have occupied for the purposes of discovering whether there is any adverse financial information recorded against you or your close family.
You must advise all the persons mentioned on this baseline security form that these checks will be made.
Any relevant information disclosed will be assessed and may be a bar to your employment by Police Forces in the East Midlands.
Any infringement of an individual’s right to respect of family life under the European Convention on Human Rights – ECHR Article 8, and discrimination ECHR Article 14, will only be that which is necessary and proportionate. The legitimate aims of such action will include the protection of the rights and freedoms of others, safeguarding public safety, the prevention of disorder and crime and, in some cases, national security.
The personal data supplied will be managed confidentially, securely and in accordance with the Data Protection Act 1998. Personal data will be retained in accordance with retention periods established through the national guidance on Management of Police Information, where after it will be disposed of securely. Under the Data Protection Act, individuals have a general right of access to personal data held by police forces.
Please complete the questionnaire in BLACK INK using BLOCK LETTERS. Check that you have completed ALL the questions by ticking responses as appropriate, or by providing an answer in the spaces below. Where a question is not applicable or the answer is not known or not easily obtainable, enter N/A or N/K respectively. Please note that N/A or N/K responses may cause delay to your clearance. Should you require extra space to answer questions please insert a sheet of A4.
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Please read and sign the following declaration:
I confirm that I have read the above statement regarding the vetting process above and understand it.
I confirm that all other persons mentioned on this form have been notified that their details have been submitted as part of the check and that if they withhold permission to conduct these checks then this application cannot be progressed.
I understand that if I knowingly make a false statement or deliberate omission in the information provided in the following form then I may not be employed by or on behalf of Police Forces in the East Midlands.
I also understand that any information discovered or disclosed under the vetting process will be treated confidentially.
Signed / Post Applied For______
Name (Printed)
Date
PLEASE NOTE THAT FAILURE TO COMPLETE THIS SECTION OF THE FORM MAY LEAD TO YOUR APPLICATION BEING DELAYED OR TERMINATED.
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/ SECURITY VETTING FORM
Failure to complete all the sections could delay your application
Please continue any of your answers on a blank sheet and attach it to this document if necessary
1. Applicant
Title / ForenamesSurname / National Insurance Number
Maiden Name / Male/Female
Former Surname(s) / Place of Birth
Date of Birth / Mobile Number
Home Telephone Number / All Private Email Addresses Websites/Blogs/Forums you run or contribute to :-
Occupation / Details of Previous Service in Police (Regular Force, Special Constabulary & PCSO)/HM Forces/HM Gov. (Force, Regiment etc & Service Number).
Please include dates:-
Current address (include postcode)
(Addresses to cover 5 years) / Previous Address 1 (include postcode)
Date From / Date To / Date From / Date To
Is your house lived in by three or more tenants/ residents who form two or more households?
Yes No
Previous Address 2 (include postcode) / All other addresses that cover the last 5 year period should be recorded in full, with dates to and from at each address on a continuation sheet of paper.
Date From / Date To
2. Partners Details
Please enter details of any spouse or other partner with whom you are living as a couple and/or former partners who have died or from whom you have separated or divorced in the last 3years.
Title / OccupationSurname / Forenames
Maiden Name / Male/Female
Former Surname(s)
Date of Birth / Place of Birth
If deceased, please give date of death and address before death / Please state relationship & number of years together
Address (include postcode)
(Addresses to cover 5 years) / Previous Address 1 (include postcode)
Date From / Date To / Date From / Date To
Previous Address 2 (include postcode) / All other addresses that your partner has lived in during the last 5 year period should be recorded in full on a continuation sheet, with dates to and from at each address.
Date From / Date To
3. Details of your Children and details of any Co-Residents
Please enter details of your children, including stepchildren/half children or adoptive children. There is no need to include children under 10 years of age. Use a blank continuation sheet if required.
Relationship / RelationshipSurname / Surname
Former Surname(s) / Former Surname(s)
Forenames / Forenames
Date of Birth / Date of Birth
Place of Birth / Place of Birth
Address (incl. postcode) / Address (incl. postcode)
Since / Since
If deceased, please give date of death and address before death / If deceased, please give date of death and address before death
4. Parents Details
Please enter details of your natural parents, including adoptive parents, stepparents, guardians and their current partners. Use a blank continuation sheet if required.
Father / MotherSurname / Surname
Former Surname(s) / Maiden Name
Former Surname(s)
Forenames / Forenames
Date of Birth / Date of Birth
Place of Birth / Place of Birth
Address (incl. postcode) / Address (incl. postcode)
Since / Since
If deceased, please give date of death and address before death / If deceased, please give date of death and address before death
Father's Partner (if applicable) / Mother's Partner (if applicable)
Surname / Surname
Maiden Name / Maiden Name
Former Surname(s) / Former Surname(s)
Forenames / Forenames
Date of Birth / Date of Birth
Place of Birth / Place of Birth
Address (incl. postcode) / Address (incl. postcode)
Since / Since
If deceased, please give date of death and address before death / If deceased, please give date of death and address before death
5. Brothers and Sisters Details
Please enter details of your brothers and sisters, including half/adopted or stepbrothers and half/adopted or stepsisters. There is no need to include brothers and sisters under 10 years of age. Use a blank continuation sheet if required
Relationship / RelationshipSurname / Surname
Maiden Name / Maiden Name
Former Surname(s) / Former Surname(s)
Forenames / Forenames
Date of Birth / Date of Birth
Place of Birth / Place of Birth
Address (incl. postcode) / Address (incl. postcode)
Since / Since
If deceased, please give date of death and address before death / If deceased, please give date of death and address before death
If there is insufficient space to complete your answers to questions 6 to 10 below. Please complete on a separate piece of paper and attach to this form.
6. Financial Details
In the last 6 years have you: / Yes No / Show full information in respect of all questions.Had a loan arrangement terminated by a bank/building society/finance house?
Had a credit/charge card withdrawn or defaulted?
Had arrears with any existing loan/mortgage/hire purchase agreement?
Been registered bankrupt?
If yes, have your bankruptcy debts been discharged? *
Had any Court action taken against you for any debt?
Been party to a Voluntary agreement registered with the County Court? (IVA, Debt Referral Order (DRO))
Been party to a Debt Management Programme or loan consolidation process?
Had a County Court / Tribunal
Judgement been made against you?
If yes, has this been cleared?
Had repossession proceedings commenced against you?
ADDITIONAL INFORMATION
7. Security Information
A You must declare below any convictions, including those which are spent, cautions, summons, reprimands, warnings or fixed penalty notices. You must also declare if you have been the subject of any investigations either by Police, Military and/or other statutory prosecuting authorities (HMRC, Border Agency, etc) including those pending, or been the subject of Police disciplinary service confidence procedures. In accordance with the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders (Northern Ireland) Order 1978 (Exceptions) Order 1979 spent convictions may be taken into account where National Security is concerned.
Note that your answers will apply to all such issues in the UK or abroad.
Have you ever been:
Investigated by the Police / Yes* NoArrested by the Police / Yes* No
Summonsed for an offence by the Court/Police / Yes* No
Charged for any offence by the Police / Yes* No
Issued a Fixed Penalty Notice / Yes* No
Convicted of any offence, including traffic offences (excluding parking) / Yes* No
Cautioned/Reprimanded/Warned/Finally Warned for any offence including traffic offences / Yes* No
Issued with an Anti Social Behaviour order (ASBO), football spectator banning order, risk of sexual harm order or domestic violence or harassment order / Yes* No
Have you ever in Scotland:
Accepted a fiscal fine from the Procurators Fiscal / Yes* No
Appeared before a Court Martial / Yes* No
Are you currently subject of any criminal investigation
If yes, please provide details below / Yes* No
The subject of any adverse finding(s) resulting from a Police disciplinary or other employment related enquiry or service confidence procedures? / Yes* No
*If Yes to any of these questions, please describe below:-
B / Have you ever been involved in any actions that could be described aspolitically, religiously, racially or environmentally disruptive actions? / Yes* No*If Yes, please describe below:-
C / Are you a member of the British National Party? / Yes* NoD / Are you aware of any circumstances or characteristics that may impact on vetting clearance? / Yes* No
*If Yes, please describe below:-
8. Associations
Do you associate with any person(s) (including family members) who you know or have reason to believe has criminal convictions or is engaged in criminal activities or is a person who associates regularly with such persons.Yes No
If Yes please complete the boxes below giving the name(s), address(es) and dates of birth of the person(s) you have contact with, if this information is known to you. Do not carry any checks or cause any checks to be carried out to obtain this information.
Name(s) / Address(es) – if known / Date of Birth – if known
9. Suitability to work with or for the Police
Yes No
If ‘Yes’ please outline reasons on a separate sheet which can be sealed in an envelope marked ‘In Confidence – for the attention of the Force Vetting Unit’ and attached to this form.
10. Have you previously been the subject of a vetting procedure by another Police Force or Agency?
Yes No If Yes, please provide details below of Police Force/Agency with outcome.
Force/Agency: / Outcome:Date:
DECLARATION
· I consent to the information provided on this form being used by the Vetting Unit for the purposes of vetting.
· I declare that the information I have given is true and complete to the best of my knowledge and belief.
· I undertake to notify any material changes in the information I have given.
· I consent to a financial check being carried out.
· I understand that any false statement or deliberate omission I have given in this questionnaire may disqualify me for the position applied for and may make me liable to disciplinary action.
· I understand it is my responsibility to inform those named on the form that their details have been provided for the purpose of my vetting application.
Signed / Dated· (Serving Staff and Officers undergoing Management or SC Vetting only) I understand that if I have answered ‘Yes’ to question 9, then the matter may be referred to the Force Medical Officer for an opinion. I consent to a report being forwarded to the Vetting Unit and (if applicable) my line manager. A copy will be sent to me at the same time. No confidential medical information will be included without my consent.
Signed / DatedPrivacy Notice: Leicestershire Police processes personal data in accordance with the Data Protection Act 1998 and other associated legislation. Information provided will be retained securely within the Force Vetting Unit for the purpose of managing the vetting aftercare process and will only be shared or disclosed to other organisations where there is a legal basis to do so.
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