Community Speed Watch Application Form & Vetting Form
Please send this form to:
PERSONAL DETAILS
Family Name: / Title
First Name(s)
Current Home Address
Post Code
Home Telephone / Mobile Telephone
Home e-mail address
I would describe my ethnic origin as (optional):
Asian or Asian British / Black or Black British / Chinese or other
White / Mixed / Other
TEAM AND TRAINING DETAILS
Which CSW team will you be associated with?
......
Have you made contact with the team leader?
......
Do you require contact details for the team leader?
......
Definition of Disability
Section 1 of the Disability Discrimination Act defines a person as having a disability if he or she `has a physical or mental impairment’ which has a `substantial’ long term adverse effect’ on his or her ability to carry out `normal’ day to day activities.Do you consider yourself to have such a disability?YES / NO
Please describe the nature of your disability:
Do you have any access requirements for the training session? YES /NO
If yes, please advise......
...... / Which training session are your applying for?
Please tick
Wednesday 20 September 2017,4pm – 6pm □
Closing date: 30August2017
Saturday25November 2017, 10am – 12pm □
Closing date: 04November 2017
Thursday 18 January 2018, 1600 – 1800 □
Closing date: 29 December 2017
Saturday 3 March 2018, 1000 - 1200 □
Closing date: 10 February 2018
All of the above training sessions listed are
held at HQ
INCOMPLETE APPLICATION & VETTING FORM WILL NOT BE PROCESSED AND RETURNED.
PLACES CANNOT BE RESERVED. PLACES ARE ALLOCATED AFTER THE CLOSING DATE ON FIRST COME FIRST SERVED BASIS.
You will receive a receipt of application within approximately one week from the date of receipt and confirmation of place allcoated after the closing date shown above.
DATA PROTECTION ACT 1998 – the information you supply on this form may be used on a computerised system.
Thisquestionnairemustbe completedfullybeforetheSecurityVettingprocesscancommence.
Section 1 – APPLICANT DETAILS – COMPLETE ALL BOXES
Ensure you include all surnames/last names/family names you have ever used.
Family Name: / Title
First Name(s)
Previous Family Name(s) (if any)
Date of Birth / Surname at Birth
Town of Birth / Country of Birth
National Insurance Number / Nationality
Section 2 – CURRENT ADDRESS
Include full details and postcode
Current Home Address
Postcode
Home Telephone / Mobile Telephone
E-mail address:
(this will be used for all contact so please ensure it is correct)
Section 3 – NEXT OF KIN
Name:
Current Home Address
Postcode
Relationship to you:
Contact phone number(s):
Section 4 – PREVIOUS CONVICTIONS AND CAUTIONS
Haveyoueverbeenarrested/cautionedorconvictedofacriminaloffence(includingtraffic/speedingoffencesandallspent / Yes No
If youhave answered‘Yes’ toanyofthe above,please enter details
Date / Offence / Result / Court
Section 4. Criminal Associates
Include information within your knowledge and please note that omissions could affect the outcome of the Security Clearance process. Do not carry out checks or cause checks to be carried out.
Do you have any relative or associate (including co-resident) who you know or have reason to believe has criminal convictions (excluding traffic convictions), OR is engaged in criminal activities, OR is a person who associates regularly with such persons? / Yes
No
If youhave answered‘Yes’ toanyofthe above,please enter details
Name / Address / Date of Birth / Relationship
Section 5. Extremist Groups
Include information within your knowledge and please note that omissions could affect the outcome of the Security Clearance process. Do not carry out checks or cause checks to be carried out.
Do you or any relative or associate belong to or have contact with any group or organisation using criminal means to achieve objectives (such as extreme animal rights or environmental groups) or whose aims or pronouncements may contradict the duty to promote race equality? / Yes
No
If youhave answered‘Yes’ toanyofthe above,please enter below
Section 6 – DECLARATION
Read this section carefully, tick the boxes, sign and date
- I understand that information coming into my possession or knowledge as a consequence of my employment, contract or other work with Wiltshire 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 dismissal, termination of contract, civil liability and / or prosecution.
- 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 the information I have provided may be held on manual filing and computer systems as part of the process. This information may be shared with other police forces.
- I understand that Wiltshire Police will record the data I provide for vetting. Personal data collected on this form will be treated in the strictest confidence and will remain within the Personnel Security Vetting Unit. The police national computer and other computerised systems, including financial 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.
Signature / Date
Print Name
1
Sept2016 v6