Disclosure of Criminal Conviction

The job/placement for which you are applying involves substantial opportunity for access to children or vulnerable adults. It is therefore exempt from the Rehabilitation of Offenders Act, 1974 and subject to a Criminal Records Disclosure at enhanced level in accordance with the requirements of the Criminal Records Bureau and the Police Act 1997. You are required to declare any convictions or cautions you may have, even if they would otherwise be regarded as “spent” under this Act and any cautions or bind-overs. The information you give will be treated in confidence and will only be taken into account in relation to an application where the exemption applies.

The disclosure of a criminal record, or other information will not debar you from appointment/placement unless the Council considers that the conviction renders you unsuitable for appointment. In making this decision the Council will consider the nature of the offence, how long ago and what age you were when it was committed as well as any other factors which may be relevant, including appropriate consideration in relation to the Council's published Equal Opportunities Policy.

Failure to declare a conviction, caution or bind-over may, however, disqualify you from appointment, or result in summary dismissal if the discrepancy comes to light. If you would like to discuss whether a conviction you have would be likely to debar you from working with children or vulnerable adults you may telephone the HR Recruitment Team on 236333.

Date

Offence

Details (please tick)

Court / Police force

that dealt with the offence(s)

Pending prosecution

Conviction

Caution

Bind-Over

Pending prosecution

Conviction

Caution

Bind-Over

Pending prosecution

Conviction

Caution

Bind-Over

Pending prosecution

Conviction

Caution

Bind-Over

Please give any further details that are relevant

Signed as a correct statement:

Please PRINT full name:

Date of signature:

Once completed and signed this form should be brought to interview