APPLICATION
for the position of Independent Member
to sit on Police Misconduct Hearings
Information for Candidates – Please read these instructions carefully
If you would like this application form in any other format, call 0151 777 5155 and ask for format of your
choice.
The form should be completed in black ink or word-processed (of not less than 10 point)
You are strongly advised to read the job description, the competencies in the person specification and the
eligibility criteria.
Successful applicants will be required to complete the police vetting process prior to appointment.
Applicants are required to complete all sections of the application form.
Be as succinct and concise as possible although not to the point of omitting critical information. If there is
insufficient space please continue on a separate sheet making clear which question is being answered.
All information you want to convey MUST be contained within the application form (or on the supplementary
sheets as specified). In deciding who to call for interview no additional information will be taken into
account. You are asked not to submit a Curriculum Vitae.
It is your responsibility to ensure the application form and equal opportunities monitoring form are
completed and are returned to the specified address and by the date and time given.
It is imperative that you are open and honest with your answers. Evidence needs to be specified and focussed
on your personal involvement/experience and actions. The evaluation of your application will be determined
by the extent that your evidence relates to the requirements of the role, how thoroughly you answer the
questions and how appropriate your examples are in relation to the role of independent member on police
misconduct panels.
INDEPENDENT MEMBERS OF MISCONDUCT PANELS – APPLICATION FORM
1. PERSONAL DETAILS
TITLE (Mr/Mrs/Ms/Dr. etc)
NAME IN FULL (Please also give any other names by which you have been known)
PERMANENT HOME ADDRESS (applicant must reside within the northwest region – see information for
applicants)
HOW LONG HAVE YOU LIVED AT THIS ADDRESS?
IF LESS THAN FIVE YEARS AT THIS ADDRESS, PLEASE GIVE DETAILS OF YOUR PREVIOUS ADDRESS(ES)
DAYTIME TELEPHONE NUMBER
EVENING TELEPHONE NUMBER
MOBILE TELEPHONE NUMBER
EMAIL ADDRESS
DATE OF BIRTH
NATIONALITY
ARE YOU A SERVING OR RETIRED POLICE OFFICER, POLICE STAFF, SPECIAL CONSTABLE OR STAFF OF THE OFFICE
OF THE POLICE AND CRIME COMMISSIONER, OR ARE YOU RELATED TO ANY OF THE ABOVE? IF YES, PLEASE GIVE
DETAILS BELOW
YES ☐ NO ☐
2. SKILLS AND EXPERIENCE
In this section please outline what skills, experience and particular strengths you would bring as an
independent member and what you understand to be the role of an independent member (please continue on
a separate sheet if necessary).
You may find it helpful to refer to the job description and person specification.
[skills and experience continued…..]
3. EMPLOYMENT HISTORY
In this section please outline your previous employment history and current occupation (if a position is
currently held)
4. REFERENCES
Please give details of two people, not related to you, who have agreed to be contacted by us about your
application.
1. Name
2. Name
Address
Address
Tel no.
Tel no.
Email
Email
Occupation
Occupation
5. CONVICTIONS
Have you any unspent convictions? (check one box)
Yes ☐
No ☐
Please list below all unspent convictions in chronological order.
Please note: under the Rehabilitation of Offenders Act 1974, following a certain period of time which depends
on the sentence imposed, all convictions except those resulting in prison sentences of more than 2.5 years are
regarded as spent. This means that sentences of up to 6 months become spent after 7 years and those of
between 6 months and 2.5 years are regarded as spent after 10 years.
Have you any spent convictions? (check one box)
Yes ☐
No ☐
Please list below:
Please note that a criminal record check will be made on all successful applicants prior to appointment.
6. PLEASE SIGN AND DATE THIS FORM
I declare that the information I have given is true and complete
Signed ………………………………………………………………………………………
Date …………………………………………………………….
7. WHAT TO DO NOW
Please return this completed application form and monitoring questionnaire by 5pm on 27th January 2016 via
post or email to:
Joanne Liddy
Chief of Staff
Office of Police & Crime Commissioner for Merseyside
Allerton Police Station
Rose Lane
Liverpool
Merseyside
L18 6JE
Email: [email protected]
If you have any questions or require further information please contact Sue Foster on 0151 777 5155.
MONITORING EQUALITY AND DIVERSITY
The North West Police and Crime Commissioners are committed to treating everyone who uses their services fairly
and with respect.
The Commissioner seeks to ensure that the overall list of independent members is representative of the local
community and provides a suitable balance in terms of age, gender and ethnicity. This form will assist us in
monitoring the diversity of our members.
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
Under 16
41 – 60
16 - 25
60+
26 - 40
Prefer not to say
35 - 44
*
*
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?
Yes
No
Prefer not to say
Please specify any arrangements we can make to assist you if you are invited for interview/assessment
* Return with completed application form