Monitoring Questionnaire

Thank you for your interest in the Monitoring Questionnaire for the Northamptonshire Police and Crime Commissioner.

Title*
First Name(s)*
Last Name*
Any other names you have been known by
Permanent Home Address*
Number of years at this address*
(If less than 5 years please complete previous address)
Previous Address
Number of years at this address
Date of Birth*
Age*
Place of Birth*
Nationality*
National Insurance Number*
Home Telephone Number*
Work Telephone Number
Mobile Telephone Number
Email*
Mystery Shoppers need to be impartial and independent. To enable us to identify any possible conflicts of interest please complete the section below.
Are you a police officer or special constable?*
Are you a member of police staff?*
Are you a volunteer for Northamptonshire Police?*
Are you a member of staff of the Northamptonshire Office of the Police and Crime Commissioner, or their immediate family?*
If you have answered yes to any of the above please provide further details:
Please provide us with details of any part-time or full-time work over the last 5 years:*
Please include 'Name and address of employer' 'Dates' and 'Position held and duties'
Do you do any other voluntary work or public service?*
If 'Yes' please give details below:
Why do you want to be a Mystery Shopper?*
Do you have a current full car or motorcycle license?*
This will not affect your application but may influence which tasks you are set, if successful.
Please tell us what skills, experience and qualities you have that would make you a good Mystery Shopper.*
You may want to include your experience of good communications skills or any voluntary duties or public service you are involved in.
Do you consider yourself to be disabled?*
Do you have any medical condition that may affect your ability to carry out the duties of a Mystery Shopper?*
Are there any special arrangements you would require if attending an interview? (eg. access, disabled parking)*
If you have answered 'Yes' to any of the above questions please provide more details below.
This will not necessarily affect your application.
**The Police and Crime Commissioner is an equal opportunity employer and actively encourages applications from people with disabilities. Applicants with disabilities who demonstrate that they meet the essential criteria in the Person Specification will be guaranteed an interview. The Disability Discrimination Act 1995 defines a disabled person as someone who has “a physical or mental impairment which has a substantial and adverse long-term effect on his or her ability to carry out normal day-to-day activities.”**
In the last five years have you had any criminal convictions or been convicted of any offence punishable by imprisonment?*
If you have answered 'Yes' to the above question please provide more details below.
The inclusion of this question and the provision of the information is a requirement in all applications but may not necessarily affect your application. Offences covered by the Rehabilitation of Offenders Act 1974 need not be declared above if spent.
To help us with recruitment in the future please advise how/where you learnt that we were looking for Mystery Shoppers?*
Please give the name of two referees who have agreed to support your application.*
One should be a professional e.g. teacher/solicitor, accountant/community leader. The other can be a character reference who should have known you for at least 2 years (and should not be a family member)
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DECLARATION - By submitting this form I agree to the Police and Crime Commissioner undertaking a Police National Computer (PNC) and Force Intelligence System (FIS) check in connection with my application as a volunteer. I have read the information supplied to me concerning the duties and responsibilities of a Mystery Shopper and would be prepared, if my application is accepted, to complete the appropriate undertaking in respect of confidentiality.

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Monitoring Questionnaire

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