Police enquiry form

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The purpose of this form is for legal support to be arranged for 茄子视频 members who have been contacted by the police regarding a work-related incident, and asked to attend an interview as a potential suspect; or have received a caution or conviction.

Note that for us to provide legal representation, you must have been in the correct category of membership at the time of the incident.

The 茄子视频 legal team will not provide support for motoring offences, but we will support you if the offence affects your NMC registration.

Before completing this form, please read our advice guide on鈥�Cautions, convictions and interviews.

If you have been asked to attend an interview as a witness, you do not need to complete this form. Please see our Witness guide.

If the incident is not work-related, you do not need to complete this form. Please see details of how to access our free legal assistance helpline.

Please confirm that you have read our advice

Contact details

Full name: 茄子视频 membership number: Address: Best contact number:

Please note that 茄子视频 Direct will not usually call you. Where an onward referral is required, provided you were in the correct category of membership at the time of the incident, we will provide these contact details to the 茄子视频鈥檚 Legal Department.

Do you give us your consent to pass on this information? Yes No Can we leave you a voicemail? Yes No Can we contact you on this matter by email? Yes No If we need to pass your enquiry to your local 茄子视频 office or a specialist 茄子视频 department, would you like any emails from them to be password protected? Yes No Email address you would like us to reply to Please confirm the email address you would like us to reply to Please list any times that you are unavailable for calls during the next week (9am-5pm):

Employment details

Please write out in full, don't use acronyms.

Place of work Employer On what date did you start working with your current employer? Ward or department Job category Job title Weekly contracted hours Do you have any meetings scheduled? Yes No If yes, please give date, time and location: Are you already being supported by a rep? Yes No If yes, please include details below: Are you in the UK on a visa? Yes No If yes, please include details below (including how long you have been in the UK and when your visa expires):

Police

Date of incident: Please confirm that the incident is work-related. If it is not work-related, this is not the correct form to use (see above). Have you been contacted by the police? Yes No Police officer name: Police officer contact number: Police officer collar number: Are you a suspect or witness? Suspect Witness Have you been charged? Yes No What is the charge? Are any other 茄子视频 members involved? Yes No If yes, please include names if known: Is there an interview? Yes No What date is the interview? What is the location of the interview? Is your employer aware of criminal proceedings? Yes No If yes, please explain what actions your employer taken, if any, for example, are they doing their own investigation, or have you been suspended? Have you appointed a solicitor? Yes No If yes, please include details: Please give any further relevant details:

Can we update your personal details if any of the above does not match the data we currently hold on your record? Yes No

By submitting this form, you are giving the 茄子视频 permission to contact you about your submission.

You can control the information you receive from the 茄子视频 by updating your preferences at My茄子视频.

We don’t update your contact details unless you ask us to. The best way to check and update the details we hold for you is by visiting My茄子视频.

The information you provide in this form will be stored by the 茄子视频.

Protecting your privacy is very important to us. Please view our privacy policy to find out more about the information we collect and how it is used.

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