RESTRICTED – Staff (when completed)

Section 1 – Applicant Details

Surname:

(Mr, Ms, Mrs, Miss)MrMsMrsMiss /

First Names:

Surname at Birth: / Other Surnames:
Date of Birth: / Town and Country of Birth:
Day / Month / Year
House No / Name: / Street Name:
District: / Town / City:
County: / Post Code:
Time lived at the above address: / Have you been a resident in the UK for the last 3 years?:
Yes No:
Home Number: / Mobile Number:
Email:
Please provide a short paragraph detailing why you would like to take part in the Ride-Along Scheme:
Section 2 – Proof of Identification and Residence
 / Documents Produced / Notes
British Passport / Full 10 year current British (or EEA) Passport required
OR any TWO of the following:
British Driving Licence / NOT provisional or international licence
Full Birth Certificate / NOT if issued more than 6 weeks after birth
P45 / NOT P60
Cheque Book & Bank Card / Plus 3 bank statements and proof of signature
Credit Card / Plus 3 statements and proof of signature
Foreign Passport / Current
National Identity Card / Current
Home Office Immigration / Confirming immigration status
Section 3 – Proof of Residence
 / Documents Produced / Notes
Utility Bill / Council tax, gas, electricity, water or landline telephone bills
Section 4 – Applicant Declaration
I confirm my identify as detailed in Section 1 by production of the documents listed in Section 2 above
I confirm my address as detailed in Section 1 by production of the documents listed in Section 3 above
Signature: / Date:
Section 5 – Personnel Department / Employer Declaration
I confirm that I have examined the original documents listed above and verify that they relate to the applicant
I attach photocopies of the documents examined.
Dept. / Company: / Tel No.
Name: / Position:
Signature: / Date:
Section 6 Official Secrets Act 1911 – 1989
I understand that I will be subject to the restrictions and duties imposed by the Official Secrets Act 1911 - 1989 (The Acts) and that disclosure of any information, document or article (or part thereof) in breach of the provisions of the Acts will make me liable to prosecution.
I have been informed that information, documents or other articles protected against disclosure by the provisions of the Official Secrets Act may come into my possession in circumstances requiring it to be held in confidence. I understand that I may be prosecuted for an offence under the Official Secrets Acts 1911 – 1989 should I disclose without lawful authority any such information, document or other article.
I understand that on termination of my work with Essex Police, the restrictions on disclosure of information under the Acts and my liability to prosecution continue to apply.
Signature: ...... Date: ......
Section 7 – Data Protection Act
I understand that the Data Protection Act establishes principles that govern the manner in which personal data is used, including requirements that data is:
  • Obtained and processed fairly and lawfully
  • Held only for a specified and lawful purpose
  • Not used or disclosed other than as authorised
I also understand that I am liable for prosecution if I knowingly or recklessly use, obtain, disclose or transfer data without authority or other lawful reason.
Signature: ...... Date: ......
Section 8 – Confidentiality
I understand that information coming into my possession or knowledge as a consequence of my work with Essex Police, will be held in confidence and must only be used as authorised in connection with my official duties. I understand that the unauthorised communication of any such information to any person, either verbally or in writing, could result in a criminal prosecution.
Signature: ...... Date: ......
Section 9– Declaration
I confirm that I have completed the above form and the information given is true and correct. I understand that if any error or omission is found I will be asked to leave police premises.
I understand that Essex Police will record the data I provide for screening. Personal data collected on this form will be treated in the strictest confidence and will remain within the Corporate Vetting Unit. The police national computer and other computerised systems will be consulted to verify the details you have provided and the results of these checks will be recorded. I consent to this process.
I understand that by returning this form via e-mail and inserting my name into the signature field this will be treated as equivalent to my written signature.
I understand that completion of this vetting form does not permit me access to Essex Polices’ data or IT systems.
Signature: / Date:

Employer – Please forward to:Essex Police, P O Box 2, Springfield, Chelmsford, Essex CM2 6DA

Personnel Department / Essex Police SPOC – when completed please forward a copy to:

VettingB (26/03/13) RESTRICTED – Staff (when completed)