Police enquiry form

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The purpose of this form is for legal support to be arranged for RCN members who have been contacted by the police 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 RCN 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.

Please confirm that you have read our advice

Contact details

Full name: RCN membership number: Address: Best contact number:

Please note that RCN 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 RCN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 RCN office or a specialist RCN 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

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):

Police

Date of incident: 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 RCN 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 RCN permission to contact you about your submission.

You can control the information you receive from the RCN by updating your preferences at MyRCN.

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 MyRCN.

The information you provide in this form will be stored by the RCN.

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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