Download Safeguarding Children, Young People

Disclosure Declaration Form - Safeguarding Children,
Young People & Vulnerable Adults
Due to the nature of your services and for the purposes of the Rehabilitation of
Offenders Act Exceptions Order 1975, please provide details of any criminal
convictions, cautions etc, and the penalty or penalties imposed, whether or not
regarded as spent under the Rehabilitation of Offenders Act 1974.
Please also include details of any criminal proceedings or investigations currently
being undertaken, which involve you.
City & Guilds reserves the right to require that the applicant undertakes a Criminal
Records Bureau check. This will be at the Consultant’s expense where a disclosure
has been made.
The information received will be treated with the utmost confidentiality and will be used
by the Children and Vulnerable Adults Protection Panel to reach a conclusion as to
whether a contract or employment should be offered to the applicant. The information
received around disclosures will, unless there are exceptional circumstances, be
securely destroyed after a period of 6 months.
NB. Disclosure of offences does not in itself mean that in every instance a contract or
offer of employment will not be issued.
The City & Guilds Group strongly believes in the rehabilitation of offenders and that
gainful employment is an integral part of this process.
Therefore, after careful consideration of the individual circumstances and with due
regard to the risks to the welfare and protection of children, young people or vulnerable
adults with whom the applicant may come into contact, as part of their role with City &
Guilds, City & Guilds will make a decision which will be fair and appropriate.
In accordance with City & Guilds’ legal obligations in relation to the protection of
children and vulnerable adults, City & Guilds requires you to confirm that there has
been no change in your circumstances since the date of your most recent Disclosure
Declaration Form. If there is a change in your circumstances that requires
disclosure, please e-mail [email protected] and a new
Disclosure Declaration Form will be sent to you for completion.
Continued over
January 2012
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I can confirm that I have read and understood the Safeguarding children, young people
and vulnerable adults Disclosure Declaration and due to the nature of my services
and for the purposes of the Rehabilitation of Offenders Act Exceptions Order 1975 am
willing to provide details of any criminal convictions and the penalty imposed, whether
or not regarded as spent under the Rehabilitation of Offenders Act 1974.
(tick as appropriate)
Yes*
No
Have there been any changes to the status of your registration
with any regulatory body?
Have you been subject to criminal investigations or charges
pending (including motoring offences)
Have you any cautions/reprimands/final warnings or any other
police or court decisions taken against you or have you been
bound over
Have you ever been or are you currently subject to one of the orders stated below:

Protection of Vulnerable Adults (POVA) list (maintained by the
ISA)

Protection of Children Act (POCA) list (maintained by the ISA)

Section 142 of Education Act 2000 (formerly List 99)

Sex Offenders Register

Risk of Sexual Harm Order (RSHO)
Has any child been removed, temporarily or permanently, from
your care as a result of child protection proceedings
* If you answered ‘Yes’ to any of the above questions please give the details below:
January 2012
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Name (please print in block capitals): ……………………………………………………………..
Signature: ……………………………………………… …
Date: ………………………
Address ……………………………………………………….. Post Code………………
Return in the enclosed reply paid self-addressed envelope.
IMPORTANT NOTE
If you are including any details on the Disclosure Declaration Form send it together
with duplicate of the contract letter and the Code of Conduct Form. Please ensure that
you clearly mark the envelope: CONFIDENTIAL – FAO The Safeguarding
Department only
This is to ensure the confidentiality of any information that you have revealed.
If you are NOT disclosing any information on the Disclosure Declaration Form, please
send all the forms together in the envelope provided without making any
amendment to the envelope.
January 2012
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