Applicationfor thepost of

CHIEFCONSTABLE

Merseyside Police

NAMEOF APPLICANT:

Page 1 of 19

1 – Details of Candidate
Surname: / Forename(s):
Please also give any other names by which you have been known:
Current JobTitle: / Current ForceDept/Unit/Division:
Work Address: / CorrespondenceAddress:
Telephone: / Telephone:
E-mail: / E-mail:
Pleaseprovidedetailsof any specialarrangementsyouwouldrequireon the dayof your assessment(e.g.buildingaccess):
The Office of the Police & Crime Commissioner for Merseysideiscommittedtoequalityanddiversityandwelcomesapplicationsfromallsuitablyqualifiedcandidates

2 – Experience

Please provide details of your past 3 posts, startingwith the current or most recent.

RoleTitle: / Force:
Start Date: / FinishDate (if applicable):
Brief descriptionof roleandresponsibilities,including keyachievements (max 300 words):
Previous RoleTitle: / Force:
Start Date: / FinishDate:
Brief descriptionof roleandresponsibilities,including keyachievements (max 300 words):
Previous RoleTitle: / Force:
Start Date: / FinishDate:
Brief descriptionof roleandresponsibilities,including keyachievements (max 300 words):

Details of relevant training attended

Please list any educational qualifications you consider are relevant to the role for which you are

applying.

Colleges, university attended or correspondence courses taken / From / To / Qualifications and grade attained

Please list any training courses attended that you consider are relevant to the role for which you are applying (you should include here details relating to the Senior Police National Assessment Centre and the Strategic Command Course).

Course Title / From / To / Summary of course contents

Please provide details of any Equality, Diversity and Human Rights training you have received.

Course Title / From / To / Summary of course contents
3 – Key Personal Competencies
For each competency set out below please briefly describe how you meet the competency and provide an example.
Please refer to the personal qualities for descriptions of the competencies outlined (see Personal Qualities document in the Information Pack).
Serving the Public
Applicant’s response (max 200 words)
Referee Name:
/
Contact number:
Referee Signed:
Official Use – Assessor Notes
/
Rating:
Leading Strategic Change
Applicant’s response (max 200 words)
Referee Name:
/
Contact number:

Referee Signed:

Official Use – Assessor Notes

/

Rating:

Leading the Workforce

Applicant’s response (max 200 words)

Referee Name:

/

Contact number:

Referee Signed:

Official Use – Assessor Notes

/

Rating:

Managing Performance

Applicant’s response (max 200 words)

Referee Name:

/

Contact number:

Referee Signed:

Official Use – Assessor Notes

/

Rating:

Professionalism

Applicant’s response (max 200 words)

Referee Name:

/

Contact number:

Referee Signed:

Official Use – Assessor Notes

/

Rating:

Decision Making

Applicant’s response (max 200 words)

Referee Name:

/

Contact number:

Referee Signed:

Official Use – Assessor Notes

/

Rating:

Working with Others

Applicant’s response (max 200 words)

Referee Name:

/

Contact number:

Referee Signed:

Official Use – Assessor Notes

/

Rating:

4 – Disclosure

Pleasegivedetailsbelowofanyoutstandingcriminalinvestigationsordisciplinary proceedingsbeingcarriedout inrelation toyour conduct andof anypreviousdisciplinary offences whichhavenot beenexpunged.

Number of days sickness absence over the last 12 months ______

5 – Administration

Where did you see the post advertised?

Please give details of any relationships to members/officers of Merseyside Police or Office of the Police & Crime Commissioner for Merseyside. (Answer “none” if no relationship exists).

Canvassing members of the Office of Police & Crime Commissioner for Merseyside either directly or indirectly will disqualify a candidate from appointment.

Do you hold a current driving licence? Please provide type (provisional or full) and details of any endorsements or penalty points.

DECLARATION

Signature:......

Name:......

Date:......

Please return your completed application form by no later than5pm on Monday 15th February 2016via email

And in hard copy by no later than Wednesday 17 February, 2016

Dr Joanne Liddy

Chief of Staff

Office of the Police and Crime Commissioner for Merseyside

Allerton Police Station

Rose Lane

Liverpool

L18 6JE

Appendix A

MONITORING EQUALITY AND DIVERSITY

The Office of the Police & Crime Commissioner for Merseyside and Merseyside Police are committed to treating everyone who uses their services fairly and with respect.

This form will assist us inmonitoring the diversity of Merseyside Police’s employees.

You do not have to fill in this form, but it will assist us to offer better services. The information you provide will only be used to check what we do. We will always follow the laws that protect against its misuse such as the Data Protection Act 1998.

Gender
Male Female Prefer not to say
Is your gender identity the same as the gender you were assigned at birth?
Yes No
Ethnic Origin
White / Welsh / English / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Other White (please state)* / *
Mixed / multiple ethnic groups / White and Black Caribbean
White and Black African
White and Asian
Other Mixed (please state)* / *
Asian / Asian British / Indian
Pakistani
Bangladeshi
Chinese
Other Asian (please state)* / *
Black/ African/ Caribbean/ Black British / African
Caribbean
Other Black/African/Caribbean (please state)* / *
Other ethnic group / Arab
Other ethnic group (please state)* / *
Prefer not to say
Religion/Belief
Buddhist / Muslim
Christian / Sikh
Hindu / No Religion
Jewish / Other
Prefer not to say
Sexual Orientation
Bisexual / Gay man
Heterosexual / Lesbian
Other / Prefer not to say
Age
16 - 25 / 46– 59
26 - 35 / 60+
36 - 45 / Prefer not to say
Disability
The Disability Discrimination Act defines a disabled person as someone with a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities. (e.g. has lasted or is expected to last over 12 months)
Do you consider yourself to be disabled according to this definition?
YesNo Prefer not to say
Please specify any arrangements we can make to assist you if you are invited for interview/assessment

Please return with completed application form

Page 1 of 19