CONVICTION HISTORY
*
If you have never been convicted of a criminal offence or never received a caution, reprimand or warning then please select
‘No’ below. If you have been convicted of a criminal offence, or received a caution, reprimand or warning that is now spent
according to DBS filtering rules*, then please select ‘No’ below.
If you have an unspent criminal offence, caution, reprimand or warning (according to DBS filtering rules*), please
select ‘Yes’ below.
For exceptions to this legislation or for more information please refer to the Rehabilitation of Offenders Act 1974 and the
DBS filtering guidance*.
Having read the above, do you have any unspent convictions; or are you at present the subject of a criminal investigation/
pending prosecution?
POLICE INVESTIGATION
*
Have you ever been the subject of a police investigation that didn’t lead to a criminal conviction?
*
To your knowledge have you ever had any allegation made against you, which has been reported to, and investigated by,
Social Services/Social Work Department (Children’s or Adult Social Care)?
*
Has there ever been any cause for concern regarding your conduct with children, young people, vulnerable adults? Please include any disciplinary action taken by an employer in relation to your behaviour with adults.
DECLARATION
*
To help us ensure that we are complying with all relevant safeguarding legislation, please read the accompanying notes and
complete the following declaration.
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Today's Date
MM
DD
YYYY
Legalese – attached notes
The Disclosure of any offence may not prohibit employment. Please refer to our Rehabilitation of Offenders / Model Equal
Opportunities Policy�
As this post involves working contact with children, young people and/or vulnerable adults all applicants who are offered an
appointment will be asked to submit to a criminal records check before the position can be confirmed. You will be asked to apply
for an Enhanced Disclosure through the Disclosure and Barring Service (DBS) (England & Wales) or through Access NI if you are in
Northern Ireland or through Disclosure Scotland if you live in Scotland�
As the position is exempted under the Rehabilitation of Offenders Act this check will reveal details of cautions, reprimands or final
warnings, as well as formal convictions not subject to DBS filtering rules. Because of the nature of the work for which you are
applying, this position is exempt from the provision of section 4(ii) of the Rehabilitation of Offenders Act 1974 (Exemptions Orders
as applicable within the UK), and you are not entitled to withhold information about convictions which for other purposes are
‘spent’ under the provisions of the Act with the exception of those that are subject to the DBS filtering rules.
In the event of appointment, any failure to disclose such convictions could result in the withdrawal of approval to work with
children or vulnerable adults within the church/organisation. This process is subject to a strict code to ensure confidentiality, fair
practice and security of any information disclosed�
The DBS Service Code of Practice and our own procedures are available on request for you to read� It is stressed that a criminal
record will not necessarily be a bar to appointment, only if the nature of any matters revealed could be considered to place children
or vulnerable adults at risk�
As a place of worship/organisation we agree to abide by the Code of Practice on the use of personal data in employee/employer
relationships under the General Data Protection Regulations effective from May 25th 2018, as well as the expectations of the DBS�
Notes - Children and Young People
Under the Protection of Freedoms Act 2012 it is an offence for any organisation to offer employment to anyone who has been
convicted of certain specific offences, or included on either of the two barred lists held by the Disclosure and Barring Service
where the post falls within the scope of regulated activity (as defined by the DBS, under the Safeguarding Vulnerable Groups Act
2006 and the Protection of Freedoms Act 2012). An enhanced with barred list check must be completed. Those working with
children and / or vulnerable adults in posts which fall outside the scope of regulated activity may still be eligible for an enhanced
disclosure WITHOUT a barred list check�
The DBS offers both an enhanced check and for those engaged in regulated activity an enhanced with a barred list check� For
applicants in Scotland and Northern Ireland, similar provisions apply�
DBS Eligibility from: thirtyoneeight.org/dbs-links
