PLEASE COMPLETE IN BLACK INK OR TYPE. THIS WILL GIVE US CLEAR PHOTOCOPIES

Family Name ______First Name(s): ______Title: ______

Address: ______

______Postcode: ______

Telephone: HOME ( ______) ______DAYTIME (______) ______

E-mail Address: ______

Name and Address of Employer ______

Position Held: ______From: ______To: ______

Brief Outline of Duties and Responsibilities ______

This section should be used to tell us about your previous experience from employment/voluntary or unpaid activities. Please list the most recent first. Please use continuation sheets if necessary.

From / To / Position / Employer/Organisation
(full name and address and nature of employment)
¨  This section is the most vital part of the form. We need you to give us specific information in support of your application in order for us to shortlist in a fair and unbiased way.
¨  You must be able to demonstrate that you can satisfy the essential criteria on the person specification
¨  Experience is not just gained through full-time work. Experience can also be gained through voluntary work, part-time work, college or school based projects, job clubs or home life, etc.
¨  Use the criteria in the person specification as headings for your response. / ¨  It will not be sufficient merely to duplicate what the Person Specification states. For example, if it asks for “ability to” or “commitment to”, you will be required to give practical examples where appropriate of your ability, commitment, knowledge and experience by some reference to your academic, professional, voluntary or personal life.
¨  This part of the form can be completed by word processor, typewriter or by hand. This can be done on separate sheets.
¨  If you use continuation sheets please make sure you mark each sheet clearly with your name and the job for which you are applying.

Please give the name, address and contact number of two people who can provide us with an assessment of your suitability for this position.

FIRST REFERENCE

Name: ______Address: ______

______Telephone:______

Job Title ______Connection with you: ______

SECOND REFERENCE

Name: ______Address: ______

______Telephone:______

Job Title ______Connection with you: ______


Have you ever been convicted of an offence punishable by imprisonment within the last five years,

or have any criminal convictions, cautions, reprimands or final warnings?

YES/NO

If yes, please give details. The completion of this question and provision of this information is a requirement in all applications, but may

not necessarily affect your application. Offences covered by the Rehabilitation of Offenders Act 1974, if spent, need not be listed.

Do you or have you previously had a contractual relationship with any organisation that may create a conflict of interest

YES / NO If yes, please enclose details with your application form.

Are you related to or do you have a personal friendship with a member or officer the Councils referred to above?

YES / NO If yes, please enclose details with your application form giving details of the name and the relationship.

I agree to The Office of the Sussex Police and Crime Commissioner making an enquiry in connection with my application as an Independent Audit Committee Member.

I have read the information supplied to me concerning the duties and responsibilities of an Independent Audit Committee Member.

If my application is accepted, I would be prepared to make myself available as necessary and complete the appropriate undertaking in respect of confidentiality.

I declare that the information I have provided is accurate to the best of my knowledge and belief

NAME

SIGNATURE

DATE

For further information & advice contact:

Samantha Bleach • Tel: 01273 482570 • Email:

Please return completed application form to:

Samantha Bleach • The Office of the Sussex Police & Crime Commissioner

Sackville House • Brooks Close • Lewes • East Sussex • BN7 2FZ

Email: