Criminal Background Check

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Criminal Background Check
THIS FORM MUST BE COMPLETED FOR YOUR APPLICATION FOR
EMPLOYMENT TO BE CONSIDERED
The work for which you are applying for involves substantial opportunity for access to children. It is
therefore exempt from the Rehabilitation of Offenders Act, 1974. You are therefore required to
declare any pending prosecutions or convictions you may have, even if they would otherwise be
regarded as “spent” under this Act, and any cautions or bind-overs.
You are therefore required to declare below any convictions you may have even if they
would otherwise be regarded as “spent” under the Rehabilitation of Offenders Act,
including any bind-overs and cautions. You should also list any pending prosecutions.
Southwark Council and schools employing their own staff, are also entitled, under arrangements
introduced for the protection of children, to require you to complete an application to the Criminal
Records Bureau (CRB) for an Enhanced Disclosure Application. This application will be issued to
you if you are offered an appointment.
Under the Southwark Safeguarding Board requirements, you will be asked to complete a new
application every 3 years. If you have a caution, conviction or bound over in the interim period, you
should declare this to your manager or the HR department as soon as possible.
This information and that subsequently received from the Criminal Records Bureau will be kept in
strictest confidence and will be destroyed immediately after the Disclosure process is completed.
DECLARATION
Have you EVER been convicted or bound over at court cautioned or caution by the police
for ANY offence or do you have a prosecution pending?
(please tick  the appropriate box)
YES
NO
If YES please provide details overleaf of the pending prosecutions, convictions, cautions,
warnings and bind-over orders, including the approximate date, the offence, and court or
police force, which dealt with the offence.
Failure to declare a conviction, caution, warning, bind-over or pending prosecution, may
disqualify you from appointment, or result in summary dismissal if the discrepancy
comes to light.
I have read the above statement and clearly understand that failing to declare any of the above
may result in summary dismissal from my position.
It is now a criminal offence for individuals barred by the Independent Safeguarding
Authority to work or apply to work with children. Are you barred by the ISA ?
(please tick  the appropriate box)
YES
NO
CRB Disclosure Form Reference Number
F00.........................
Please complete in BLOCK CAPITALS
DATE OF BIRTH:
/
/
……………………………..
……………………………...
SURNAME:
FORENAMES:
………………………………
……………………………...
JOB TITLE:
SCHOOL/OFFICE:
………………………………
……………………………...
SIGNED:
DATE:
APPLICATION FOR THE POST OF:
JOB REFERENCE NUMBER:

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