Secondary Education

(Include education in other countries if appropriate):

Further/Higher Education

(Include education in other countries if appropriate):

a) any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or

b) any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties

One or both of the above apply to your possible work with us and covers all occupations.

You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected.

Records will be checked via the Disclosure & Barring Service procedure

(a) he has not been granted leave to enter or remain in the United Kingdom, or

(b) his leave to enter or remain in the United Kingdom: —

• (i) is invalid,
• (ii) has ceased to have effect (whether by reason of curtailment, revocation, cancellation,
  passage of time or otherwise), or
• (iii) is subject to a condition preventing him from accepting the employment.

Any employment offered will be subject to the successful applicant producing appropriate evidence that the Act is not being contravened.

I declare that to the best of my knowledge the above information, and that submitted in any accompanying documents, is correct, and

• I give permission for enquiries to be made to confirm such matters as qualifications. experience and dates of employment, and I give permission for the release by other people or organisations of such information as may be necessary for that purpose;
• I give permission for the processing of personal data contained in this form for employment purposes;
• I understand that any false or misleading information could result in my dismissal.