Staffordshire Police Citizens' Panel Recruitment Form

To join the Staffordshire Police Citizens’ Panel or related satellite panels’, please read the following information and complete the recruitment form according to your preferences.

In addition to our Citizens’ Panel, we are developing specialist satellite panels which will deal specifically with specialist policing issues. Satellite panels are being created to deal with diversity issues including disability, sexual orientation, ethnic groups and young people.We are also creating a satellite panel for the business community.

Please indicate below which panel(s) you would like to become a member of. You may select more than one panel if you wish. Then complete the remainder of the form and press the 'submit' button to confirm your interest.
(Please note: fields marked with * are required.)

I wish to become a member of the:

Citizens’ Panel

Black and Minority Ethnic satellite panel

Disability satellite panel

Lesbian Gay Bisexual and Transgender satellite panel

Youth satellite panel

Business Community satellite panel

	Forename and Surname*

Address

	House/flat number*

	Address line 1*

	Address line 2

	Town*

	City

	Postcode (please use CAPITALS)*

Gender:

Male

Female

	Date of Birth (dd/mm/yyyy)*

	Contact telephone number*

	Email address

Thank you for registering your interest in becoming a member of the Staffordshire Police Citizens' Panel or related Satellite Panels'. We will now send you a full recruitment form in the post which you will need to sign and return to us at the address shown below. Your signature will be used to indicate your voluntary agreement in becoming a member of the Panel(s).

Citizens' Panel Team
Staffordshire Police Headquarters
Cannock Road
Stafford
Staffordshire
ST17 0QG
t: 01785 232284
e: citizen.panel@staffordshire.pnn.police.uk

Staffordshire Police Citizens’ Panel Recruitment Form