Statutory Declaration Template printable pdf download

Statutory Declaration

This statutory declaration must be completed prior to a person being appointed to any

teaching or non-teaching position with a school authority unless the person being

appointed has previously provided that school authority with a statutory declaration

which was made during the same or previous calendar year.

“I___________________________of, _____________________________________

____________________________________________________________________

in the county of _________________________ aged eighteen years and upwards do

SOLEMNLY AND SINCERELY DECLARE as follows:-

that to the best of my knowledge and belief there is nothing, from a child

protection perspective, in relation to my conduct, character or personal background of

any nature that would adversely affect the position of trust in which I would be placed in

relation to children or vulnerable adults by virtue of my appointment to any teaching or

non-teaching position in any recognised primary or post-primary school or any other

state funded centre of education for children or vulnerable adults.

Within a child protection context:

I hereby confirm my irrevocable consent to each of the employing school

authorities to the making of such enquiries as they deem necessary in respect of

my suitability for the post(s) in respect of which the applications are made.

I hereby accept and confirm the entitlement of each of the employing school

authorities to reject my application or terminate my employment (in the event of

a contract of employment having been entered into) if I have omitted to furnish

the school authority with any information relevant to my application for the

position or my continuing employment with the school authority.

I understand that any false or misleading information submitted by me in

relation to my application for a position or my continuing employment with each

of the school authorities will render me liable to automatic disqualification or

render me liable to dismissal, if employed.

And I make this solemn declaration conscientiously believing the same to be true and by

virtue of the Statutory Declarations Act 1938.”

Signed: ______________________________________

Date: ______________

Applicant

Print Name:____________________________________

Declared before me

[name in capitals]

[notary

public][commissioner

for

oaths][peace

commissioner]

[practising

solicitor]by___________________________________

*who is personally known to me,

*who is identified to me by ___________________ who is

personally known to me,

Statutory Declaration Template

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