Criminal Record Declaration Form

Work in a school is exempt from the Rehabilitation of Offenders Act 1974 and all persons applying to work in school must declare convictions, cautions or reprimands, warnings or bind-overs including any that would otherwise be regarded as ‘spent’ unless they are ‘protected’ and need not be disclosed.
For guidance please go to www.gov.uk and search for ‘criminal record filtering rules’.
You are strongly advised to disclose any charges which are or may be pending.

Post applied for: *

Declaration on criminal Record

Please check/tick the boxes below that apply to you and also provide further details as appropriate:

Caution / reprimand(s) *

Yes

No

Warning / bind-over(s) *

Yes

No

Conviction pending *

Yes

No

Conviction (spent) *

Yes

No

Conviction (unspent) *

Yes

No

If yes to any of the above, please give details:

Declaration on barred list

Are you registered as barred from working with children or vulnerable people? *

Yes

No

If yes, please give details:

Declaration on sanctions

Have you ever had sanctions imposed by a regulatory body or professional association? *

Yes

No

If yes, please give details:

Do you agree to apply for an Enhanced Disclosure from the Disclosure and Barring Service without delay if your application is successful? *

Yes

No

Do you confirm that you have declared any convictions, cautions or reprimands, warnings or bind-overs including any that would otherwise be regarded as ‘spent’ except for any that you know to be ‘protected’ under the criminal record filtering rules? *

Yes

No

Signature *

Clear

Full name *

Date *

Once you complete this form you will be taken to the Equality & Diversity Monitoring Form.