Police Support Volunteer (PSV)

Application Form

for the role of

Police Support Volunteer (PSV)

When completed, this form should be emailed to the HR Shared Service Centre to:

Alternatively you can return the form to:
HR Shared Service Centre
Derbyshire Constabulary
Butterley Hall
Ripley
Derbyshire
DE5 3RS
If you are experiencing problems submitting this form, please contact the HR Shared Service Centre on 0300 122 8900

Applicant’s full name: Click here to enter text.

Role applied for: Click here to enter text.

Preferred location: Click here to enter text.

Personal details:

Personal data supplied on this form may be held or verified by computer during the process of your application. Background enquiries undertaken may include reference to personal data held on Police National Computer (PNC).

The following information is necessary for security checks to be carried out in accordance with HM Government and Leicestershire Police Security & Vetting Policies. These will only be undertaken if your registration to become a volunteer is progressed, following interview.

Title: Mr☐Mrs☐Miss☐Ms☐Surname:Click here to enter text. First name(s):Click here to enter text.

Surname at birth:Click here to enter text.Other surnames used: Click here to enter text.

Male☐Female☐Nationality: Click here to enter text.

Date of birth:Click here to enter text.Place of birth:Click here to enter text.

Full address: Click here to enter text.

Postcode: Click here to enter text.Date moved in: Click here to enter text.

Previous address:Click here to enter text.

Postcode: Click here to enter text. Date from: Click here to enter a date. To: Click here to enter a date.

Previous address: Click here to enter text.

Postcode: Click here to enter text. Date from:Click here to enter a date. To: Click here to enter a date.

Home telephone:Click here to enter text. Work telephone: Click here to enter text.

Mobile telephone: Click here to enter text.Email address:Click here to enter text.

Marital status:Single☐Married☐Co-Habitant☐

Name of spouse:Click here to enter text.Spouse date of birth:Click here to enter text.

Please list below anyone else living at your address over the age of 10 years:

(If you require more space, please use page 7)

Full Name: Click here to enter text.Date of birth: Click here to enter text.

Next of kin and contact number for emergency:

Name: Click here to enter text.Contact address: Click here to enter text.

Relationship to you: Click here to enter text. Telephone number: Click here to enter text.

Type of voluntary work:

If you have a particular area of interest you would like to become involved in, please state here: Click here to enter text.

Opportunities are varied and will be arranged and agreed with the Neighbourhood Policing Area (NPA) Deputy Commander at the time of interview.

Do you have any previous voluntary work experience?YES ☐NO☐

If 'YES', please give details below: Click here to enter text.

Availability:

Please click on appropriate boxes

Sat / Sun / Mon / Tue / Wed / Thurs / Fri
Morning / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ /
Afternoon / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ /
Evening / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ /

Skills:

Please indicate any skills you have which you would be happy to use in a volunteering role. We will use this list and the information about your availability and location preferences to match you to a suitable volunteering role.

IT skills:☐Please specify: Click here to enter text.

Admin skills:☐Please specify: Click here to enter text.

A second language:☐Please specify: Click here to enter text.

Sign language skills:☐Please specify: Click here to enter text.

Supervisory skills:☐Please specify: Click here to enter text.

Customer

Service skills:☐Please specify: Click here to enter text.

First aid skills:☐Please specify: Click here to enter text.

Do you hold a full UK Driving Licence: Yes☐No☐

Any other skills or abilities: Click here to enter text.

Details of current employment/ education:

Starting with the most recent, please give a detailed description of any full/part-time or casual employment or education, business interests or volunteering you have held in the last three years.
Name, address of business of employer or education / Position held and main duties or course title / Dates from and to / Reason for leaving
(if applicable)
Click here to enter text.
Click here to enter text.
Click here to enter text. / Click here to enter text.
Click here to enter text.
Click here to enter text. / Click here to enter a date.
To
Click here to enter a date.
Click here to enter a date.
To
Click here to enter a date.
Click here to enter a date.
To
Click here to enter a date. / Click here to enter text.
Click here to enter text.
Click here to enter text.

Other information:

We are firmly committed to the principles of equal opportunities and encourage applications from all sections of our communities. The information provided will not be used during the process of selection and will be retained by the HR Shared Service Centre for monitoring purposes.

Please tick only one box which you feel most appropriately identifies your ethnic group. An ethnic groupis a group of people who share certain background characteristics such as language, culture and religion. This provides them with a distinct identity as seen by themselves and others. Your nationality, place of birth or citizenship does not necessarily reflect your ethnic group.

White / British / ☐ / Black or Black British / Caribbean / ☐
Irish / ☐ / African / ☐
Any other White background / ☐ / Any other Black background / ☐
Mixed / White and Black Caribbean / ☐ / Asian or Asian British / Indian / ☐
White and Black African / ☐ / Pakistan / ☐
White and Asian / ☐ / Bangladeshi / ☐
Any other Mixed background / ☐ / Any other Asian background / ☐
Chinese / Chinese / ☐ / Prefer not / ☐
or other / ☐ / to say
ethnic group / Any other ethnic group

Do you consider yourself to have a disability?Yes:☐No:☐

Do you consider yourself to have a learning difficulty?Yes:☐No:☐

Please give details of anysupport you may need to assist you in the application process or in your volunteering role: Click here to enter text.

Are you a UK or EU citizen, or a commonwealth citizen, or a foreign national with indefinite leave to remain in the UK? Yes: ☐ No: ☐

Have you lived in the UK continuously for three years?Yes:☐No:☐

Are you or have you ever been a member of the British National Party (BNP) or similar organisations whose constitution, aims, objectives or pronouncement may contradict the duty to to promote race equality? Yes: ☐ No: ☐

Do you have any convictions or cautions?Yes:☐No:☐

If yes, please provide details (If you require more space, please use page 7):Click here to enter text.

Do you have any tattoos on your hands, neck, forearms or face:Yes:☐No:☐

If yes, please provide details: Click here to enter text.

Please note because of the nature of the volunteer placements mentioned overleaf, all volunteers will be required to undergo a police check. This can be a lengthy process and we are grateful of your patience and enthusiasm.

I confirm that to the best of my knowledge and belief the details I have supplied are true and correct. I understand that if it is subsequently discovered that any statement is false, any placement offered would be withdrawn. If there are any changes in your personal circumstances you must inform the HR Shared Service Centre to ensure the data held is kept up to date.

Signature: Click here to enter text. Date: Click here to enter a date.

Full name: Click here to enter text.

(Please print)

Marketing:

To enable us to monitor our public relations and marketing activity, please indicate where you found out about us:

Tick any that apply.

☐Careers office/school/college/library

☐Social media

☐Friend/family/word of mouth

☐Leicestershire Police website

☐Leicestershire Police promotional material (e.g. leaflet/brochure)

☐Local press

☐Local event e.g. recruitment fair/recruitment stand

☐Agency referral (i.e. YOS, LASBU, Social Services; please specify): Click here to enter text.

☐Other (please specify): Click here to enter text.

Continuation page:

Click here to enter text.