Surrey PA Winners
Independent Custody Visitors - Application Form
Job Description | Person Specification | Application Form

In Confidence
APPLICATION TO BECOME A SURREY INDEPENDENT CUSTODY VISITOR
Please complete all sections of this form.
Section 1 - Personal details  
Title (Mr./Mrs./Miss etc)
First Name
Surname
Other Name by which you have been known
Permanent home address
Previous home address (if less than 3 years above).
Telephone number (including area code) and e-mail address if applicable
Home
Work
Mobile
Email
Date of Birth
Place of Birth
Nationality
Occupation (or former occupation if you are retired or not currently working)
Section 2 – Further Information  
Please outline the reasons for wishing to become an Independent Custody Visitor
Please mention any other information that you feel is relevant to your application
(e.g. personal qualities/languages/skills/experience/interests/hobbies)
Have you previously served as an Independent Custody Visitor? Yes/ No (delete as appropriate)
 Yes   No
If yes, please give details
Do you have any commitments that would restrict your ability to visit at certain times of day? Yes   No
If yes, please give details:
Section 3 – Convictions  
Have you ever been convicted of a criminal offence other than one which falls under the Rehabilitation of Offenders Act 1974? Yes   No
If yes, please give details:
Section 4 – MONITORING EQUAL OPPORTUNITIES
This part of the form is used for monitoring purposes only.
The Police Authority is striving to be an Equal Opportunities Body and as such opposes all forms of unlawful or unfair discrimination. All volunteers will be recruited and trained on the basis of their ability and the requirements of the role. In order to monitor the effectiveness of our Equal opportunities Policy, we request that all applicants provide the following information by placing a tick in the appropriate box.
Gender Male   Female
Ethnic Origin  
Please note: Ethnic origin questions are not about nationality, place of birth or citizenship, they are about colour and broad ethnic group – UK citizens can belong to any of the groups indicated.
White
Indian
Bangladeshi
Pakistani
Chinese
Black-Caribbean
Black-African
Black-Other (please specify)
Other (please specify)
 
Disability  
The Disability Discrimination Act 1995 defines a disabled person as a person with a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.
Do you consider yourself disabled, as defined by the Disability Discrimination Act? Yes   No
Section 5– Declaration  
1. The information provided is correct to the best of my knowledge
2. I understand that as part of the application process appropriate police checks will be made and I consent to this.