<p> HOME OFFICE PUBLIC APPOINTMENTS SUPPORTING DOCUMENTATION</p><p>PART A: CANDIDATE INFORMATION AND REFERENCES</p><p>Please complete this form, signing the declaration on page nine, and submit with your completed application to [email protected]. </p><p>Title Forename(s): Surname:</p><p>Preferred contact details Telephone number Email address Public appointment applied for</p><p>Dates unavailable for interview</p><p>What is your principal employment, if any?</p><p>Please describe your main employment and tick the occupational sector box that best describes you </p><p>Mostly Civil Service Mostly Third Sector Mixed Mostly Private Sector Mostly wider Public Sector Prefer not to say Professional Referees Please provide the names and contact details for two referees. These must be people who know you in a professional capacity to comment on your suitability for the role. They will be expected to have authoritative and personal knowledge of your experience and achievements. Referees will not be contacted without your prior agreement. Referee 1 Referee 2 Name: Name: Position: Position: Email: Email: Phone: Phone: In what capacity do you know them? In what capacity do you know them?</p><p>Where is your principal place of residence? Please enter the County or City that you live in along with the first part of your postcode e.g. Dyfed SY23, London SE18</p><p>County Postcode </p><p>Centre for Public Appointments Database</p><p>Please tick here if you are content for us to share your CV and contact details with the Centre for Public Appointments in the Cabinet Office. They will keep this on file and they, or another Department may contact you about other opportunities that may arise in the future. All information will be handled in accordance with the Data Protection Act 1998.</p><p>PART B: EQUAL OPPORTUNITIES DIVERSITY MONITORING</p><p>2 Public appointments are made on merit in accordance with the Cabinet Office Governance Code and the Public Appointments Order in Council. By completing the attached diversity monitoring form you will be helping us meet our public sector equality duty under section 149 of the Equality Act 2012.</p><p>Your personal data will always be treated in confidence and when anonymised with data from other applications will help compile the Annual Statistical Bulletin of the Commissioner for Public Appointments.</p><p>Your responses to this section will never be made available to the panel considering your application.</p><p>Personal Details:</p><p>Current Grade / Rank Age 18-25 26-35 36-45 45-56 56-66 66 or above Prefer not to say</p><p>Gender Male Female Prefer to describe myself as Prefer not to say Where did you hear of this vacancy?</p><p>Ethnic origin: Please tick against one of the following:</p><p>White Asian British Indian Irish Pakistani Other white background Bangladeshi Chinese Other Asian origin</p><p>Mixed Ethnic Black Of more than one ethnicity African Caribbean Other Black origin</p><p>I Prefer not to say </p><p>Disability: Please tick against one of the following:</p><p>3 Do you consider yourself to have a disability? </p><p>Yes If yes, how would you describe your disability? </p><p>No Prefer not to say The Equality Act 2010 (EA) generally defines a disabled person as:  someone who has a mental or physical impairment that has a substantial and long-term adverse effect on the person’s ability to carry out normal day-to-day activities.</p><p>Any information you provide here will be used for monitoring purposes only – if you need any reasonable adjustments we will arrange these separately.</p><p>Religion or belief: Please tick against one of the following:</p><p>No Religion or Jewish Atheist Muslim Buddhist Sikh Christian Other Hindu Prefer not to say</p><p>Sexual Orientation: Please tick against one of the following:</p><p>Bisexual Gay man Other Heterosexual/straight Lesbian Prefer not to say</p><p>PART C: CONFLICTS OF INTEREST</p><p>Public confidence in the IOPC, and in the police complaints and discipline systems generally, is vital to the organisation’s success. You should note the requirement to </p><p>4 declare any potential conflict of interest that arises in the course of IOPC business and the need to declare any relevant business interests, positions of authority or connections with organisations and individuals relevant to IOPC business. Your application should provide details of any period or periods during which you have worked for the police highlighting whether during such times you ever worked in a capacity that might be perceived to compromise your independence in the eyes of the public. All Board members are expected to complete a register of members’ interests. This register will be made public via the IOPC website and is updated annually during the term of office.</p><p>In the box below, please provide details of:</p><p> Any Directorships (held in the last two years), including relevant dates and the company, possible links to the role, the Home Office, or other Government Departments (directly or indirectly). Please include any partnerships.</p><p> Any significant shareholdings in companies, which may have a relationship with the role or the Home Office, through Directorships, Trading arrangements or links (directly or indirectly) to any other Government Departments.</p><p> Any possible conflicts of interests created by virtue of the employment, working with the police, directorships or significant shareholding of a family relative or friend.</p><p> Any other matter which may give rise to a potential conflict of interest.</p><p>PART D: POLITICAL ACTIVITY</p><p>5 All applicants for a public appointment should complete the question below. The question is asked as it enables the monitoring of political activity of candidates for a public appointment so far as it is already in the public domain. Only the information provided in this section (Political Activity) below will be made available to the panel if you are called for interview.</p><p>Please indicate which of the following political activity you have undertaken in the past five years by ticking the appropriate box.</p><p>No political activity If yes, please indicate the activity undertaken:</p><p>Held office </p><p>Public Speaking </p><p>Stood for election Made donation to a political party (if so, please say how much) </p><p>Any other political party (please specify) </p><p>Name of party /parties for which activity undertaken:</p><p>PART E: INTERVIEW ACCESS SCHEME</p><p>6 Our Policy As a member of the Employers Forum on Disability, we are committed to actively encouraging applications from people with disabilities.</p><p>Applicants with a disability are guaranteed an interview if they meet the minimum criteria for the appointment, as outlined in the relevant role description</p><p>Declaring a disability for the purposes of a guaranteed interview is your decision and is entirely voluntary.</p><p>Definition of a disability The Equality Act 2010 (EA) generally defines a disabled person as:</p><p> someone who has a mental or physical impairment that has a substantial and long- term adverse effect on the person’s ability to carry out normal day-to-day activities.</p><p>Please tick, if appropriate:</p><p>I consider that I have a disability under the terms of the Equality Act 2010 and wish to apply for a guaranteed interview, providing I meet the minimum criteria for the job vacancy.</p><p>Whether you choose to apply under the Interview Access Scheme or not you can still ask us to make particular arrangements for you when attending an interview. You can also contact us if you want to discuss the criteria for the role or have questions regarding your application.</p><p>PART F: NATIONALITY</p><p>7 8 PERSONAL DETAILS</p><p>TITLE: SURNAME: </p><p>FORENAME(S): SURNAME AT BIRTH: (if different)</p><p>ANY ALIAS ANY OTHER USED: SURNAME USED:</p><p>TOWN, COUNTY, DATE OF BIRTH: COUNTRY OF BIRTH:</p><p>NATIONALITY At Birth: NATIONAL (including dual INSURANCE nationalities) NUMBER: Current: </p><p>NATIONALITY OF HOME OFFICE PASSPORT HELD: NUMBER PASSPORT NUMBER: (Immigration / nationality reference if appropriate):</p><p>EXPIRY DATE:</p><p>ISSUING AUTHORITY:</p><p>FULL PERMANENT POSTCODE: ADDRESS:</p><p>MONTH / YEAR MOVED IN:</p><p>OTHER FULL PERMANENT ADDRESS HISTORY (covering the last five years with dates resided at and postcodes):</p><p>SECURITY CLEARANCE</p><p>CURRENT OR MOST RECENTLY HELD SECURITY CLEARANCE: 9 BASELINE CTC SC DV (PLEASE TICK)</p><p>EXPIRY DATE OF MOST RECENT CLEARANCE: ISSUING AUTHORITY:</p><p>DOCUMENTATION REQUIRED AT INTERVIEW</p><p>If called to interview you will be asked to provide original documentation to verify your identity and to assist with pre-appointment checks.</p><p>A current, valid travel document, for example your passport. EEA citizens may bring either their national identity card or their passport and should also bring a residence card if they have one. </p><p>Plus two of the following: 1. Bank statements to cover the last six months; 2. Birth certificate issued at birth; 3. Adoption certificate; 4. Driving licence; 5. Utility bill / council tax bill sent to you at your given address and dated within the last six months; 6. Cheque book and bank card accompanied by three statements and proof of signature; 7. Credit card accompanied by three statements and proof of signature; 8. Credit card with your photograph on it.</p><p>Plus one of the following as evidence of employment or academic history; 1. Pay slip 2. P60 3. P45 4. Academic reference</p><p>PART G: DECLARATION</p><p>To complete your application please sign and date the declaration below:</p><p>I certify that the information included within these forms is, to the best of my knowledge and belief, true and accurate and complete.</p><p>Signed………………………………………</p><p>Dated……………………………………….</p><p>10</p>