OFFICIAL SENSITIVE
Cumbria Constabulary
Work Placement Application Booklet
Student Name: ______
Cumbria Constabulary
Work Placement Application Form
Personal Details
Surname: / Forename(s):Date of Birth: / Sex: Male/Female
Address:
Telephone Number: / Email Address:
Family Details
Please tell us about your family (wherever they live) and any other persons (aged 10+) living at your address. Provide full names including any middle names, previous family or surnames and maiden names. You should make it clear what their relationship to you is, i.e. if you are referring to your full sister you should delete brother, half and step. Continue on a separate sheet if necessary and attach it to this page. Please complete all sections or your application will be delayed.
Relationship to you: / Full name (include previous surnames and name at birth if different): / Full address (include postcode and date moved to address if known):Yourself
Date & Place of Birth
Your spouse or partner
Date & Place of Birth
Your ex-spouse or ex-partner, if still in regular contact
Date & Place of Birth
Your Mother
Date & Place of Birth
Your Father
Date & Place of Birth
Your Guardian (specify)
Date & Place of Birth
Your Stepmother
Date & Place of Birth
Your Stepfather
Date & Place of Birth
Your Brother/Sister (full/half/step etc)
Date & Place of Birth
Your Brother/Sister (full/half/step etc)
Date & Place of Birth
Your Brother/Sister (full/half/step etc)
Date & Place of Birth
Your spouse’s or partner’s
mother/stepmother etc
Date & Place of Birth
Your spouse’s or partner’s
father/stepfather etc
Date & Place of Birth
Your spouse’s or partner’s
mother’s spouse or partner
Date & Place of Birth
Your spouse’s or partner’s
father’s spouse or partner
Date & Place of Birth
Your child/child of partner
(only state if aged 10+)
Date & Place of Birth
Your child/child of partner
(only state if aged 10+)
Date & Place of Birth
Other persons (aged 10+) living
at your address (e.g. lodger)
Please state relationship to you
Date & Place of Birth
Previous Addresses (in past five years) / Dates lived at these addresses (from – to):
Education
Name of University: / Qualifications / Dates Achieved:Name of School/College: / Qualifications / Dates Achieved:
Criminal Histories
Convictions or cautions will not necessarily preclude you from a placement. It will depend on their nature and the circumstances of the offence.
Failure to disclose convictions or cautions will, however, result in your application being refused.
You must declare all convictions for any past offences, formal cautions by the police (including cautions as a juvenile, i.e. under 18 years) and any bind-overs imposed by any court. You should include traffic convictions such as speeding, drink-drive offences, fixed penalties for motoring or disorder offences, anti-social behaviour orders and any appearances before a court martial.
You must also declare any charge or summons currently outstanding against you.
You must include spent convictions under the Rehabilitation of Offenders Act 1974 (by virtue of the provisions of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975) or any involvement with civil, military or transport police.
You must also declare if you have ever been involved in any criminal investigation whether or not this led to prosecution (either of yourself or others).
Some applicants do not declare information which they believe is no longer held on record. However, our enquiries will reveal incidents from long ago and failure to disclose these will lead to your application being rejected. If you have any doubts, include the details and let us decide if they are relevant.
We will also want to know whether any of your close family or associates are involved in criminal activity and we will therefore search for any criminal convictions or cautions recorded against them. You must advise them that these enquiries will be made. The police service cannot disclose the results of these enquiries to you.
Have you ever been convicted for any offence or been formally cautioned by the police for any offence or had any bind-overs imposed by any court? (You must include traffic convictions, fixed penalties for motoring or disorder offences, anti-social behaviour orders and any appearances before a court martial. Any cautions as a juvenile should also be included.) If you have answered YES, please enter full details below. / Yes / No(Please delete as appropriate)
Date (most
recent first) / Offence/
Alleged Offence / Result
(if known) / Court/police station
involved
Do you have any impending prosecutions?
If yes, please provide full details: / Yes / No
(Please delete as appropriate)
Have you ever been involved in a criminal investigation (whether or not this led to any prosecution)?
If yes, please provide details below: / Yes / No
(Please delete as appropriate)
Have you ever been associated with criminal?
If yes, please provide details below: / Yes / No
(Please delete as appropriate)
Disability
Do you consider yourself to be disabled (see note 3 for definition) or have a learning difficulty, such as dyslexia, that you wish us to know about at this stage? / Yes / No(Please delete as appropriate)
In support of your application, please let us know whether there are any reasonable adjustments that you feel would need to be considered to assist you whilst on your placement.
Work Experience
Please give brief details of any previous relevant work experience you have had:Why do you wish to spend your work placement with Cumbria Police?
Which area/department would you like to carry out you work placement in? (Please name a specific department at HQ e.g. Legal dept, or a specific police station e.g. Workington Station)
When would the placement be required? (Please provide specific dates e.g. 03.10.16 – 07.10.16)
Declaration:
I understand that I am responsible for:
a) Maintaining a high standard of conduct and appearance at all times.
b) Transport to and from work.
c) Punctuality.
d) Informing my employer and the Constabulary in the event of illness / non-attendance.
e) Security vetting checks will be made against myself and where appropriate my family members and I have informed them of this.
Signature of Applicant:______Date:______
Cumbria Constabulary
Official Secrets Act 1989 - Declaration
Please read and sign this form before you return the application booklet to us at Cumbria Constabulary.
Employees and police officers are required to sign the Official Secrets Act on commencing employment with Cumbria Constabulary.
In effect this means that it is an offence for an individual who is bound by the Act to make any unauthorised disclosure of information, document or other article which:
- Results in an offence.
2. Leads to an escape from custody or undermines the safekeeping of individuals in custody.
3. Impedes the prevention or detection of crime or the apprehension or prosecution of suspected offenders.
It is important that as a student with the Cumbria Constabulary you are aware of the above. The Cumbria Constabulary offers you this placement on the basis that you acknowledge your own responsibility in maintaining the confidentiality of information you may obtain during your placement and sign the following undertaking:
I, ______, being a work placement student with the Cumbria Constabulary hereby acknowledge that I have read the above and I fully understand that I must not divulge to any unauthorised person any information which may come to my knowledge or into my possession during the course of my placement with the Cumbria Constabulary.
Applicant: ______Date: ______
Cumbria Constabulary
Data Protection Act 1984 - Declaration
Please read and sign this form before you return the application booklet to us at Cumbria Constabulary.
The Data Protection Act was introduced in 1984 to protect people from the misuse of information (data) and the holding of incorrect information about themselves.
The Act applies to information that has been or could be mechanically processed, for example information held on a word processor, computer printout etc, and lays down eight principles which those responsible for the information must follow:
1. Information shall be obtained fairly and lawfully
2. Information may be held for one or more specific and lawful purpose (those are kept on a national register - see below)
3. Information shall not be used or disclosed in a way that is incompatible with the specified purpose
4. Information shall be adequate, relevant and not excessive
5. Information shall be accurate and kept up to date
6. Information shall not be held longer than necessary
7. An individual shall be entitled to find out whether information is held on him / her and, where appropriate, to have it corrected or erased
8. Security measures shall be taken to ensure that information is secure from access by unauthorised people, alteration, disclosure accidental loss and destruction.
As a result of the Data Protection Act 1984, every employee of the Cumbria Police Authority is personally liable to pay compensation for damage caused by inadequate security of information held on people, staff or members of the public.
Although Data Protection does not yet apply to non-computer data, e.g. paper files, all employees of the Cumbria Police Authority are expected to respect the confidentiality of personal information whether computerised or not.
It is important that as a work placement student you are also aware of the above.
The Cumbria Constabulary offers you this placement on the basis that you acknowledge your own responsibility to maintaining the confidentiality of personal information you may obtain during your placement and sign the following undertaking:
I,______, being a work placement student with the Cumbria Constabulary hereby acknowledge that I have read and understood the above provisions in relation to the Data Protection Act 1984 and agree to abide with the directions contained therein.
Applicant: ______Date: ______
Cumbria Constabulary
Emergency Contact Details Form
Name of next of kin: ______
Emergency telephone number:
Work: ______Home: ______
Any special medical information:
______
______
______
Name of GP: ______
GP Telephone Number: ______
Applications must be completed and returned to:
CSD Employee Services
Police HQ
Carleton Hall
Penrith
CA2 5NG
Or via email to: