APPLICANTS MUST COMPLETE (SECTION 1 ONLY) AND BRING ALONG ON THE
INTERVIEW DAY
Section 1: Declaration of Cautions, and Convictions, Warnings and Bind Overs
Student Name: ............................................
Reference Number: ..................................
Date of Proposed Interview/Test: ............................
Contact Telephone Number: ................................ Email: ...................................................
The Update Service - if you have registered with the update service please provide your
Certificate number:…………………………….
This educational programme is exempt from the Rehabilitation of Offenders Act, 1974.
This means that no convictions or cautions are regarded as ‘spent’ and must be declared at interview.
All successful candidates will receive a DBS (Disclosure and Barring Service) check at the beginning of
their course.
If you have ever received any form of criminal conviction, caution, warning, reprimand or been bound
over please provide details below.
This declaration will be discussed with you at interview.
Candidate Declaration (PLEASE CIRCLE YOUR ANSWERS)
1. Have you ever been convicted of any criminal offence, been bound over or received a
warning/reprimand or caution in the UK and / or any other country?
NO
Signature: ................................................................ Date: ........................................................................
YES:
Please provide full details of the name of the offence, the date, where it occurred and the outcome, e.g.
custodial sentence, caution etc and a full description of the incident(s)
Date
Brief Description
Outcome
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2. Are you currently under investigation or awaiting action/hearings by the police or social services?
NO
Signature: ................................................................ Date: ........................................................................
YES
Please provide full details below – expanding as much as possible and continuing overleaf is required.
Failure to do so may prevent your from being considered further.
1. A full description of the incident(s), the dates and location in which it happened
Signature: ....................................................
Date: ....................................
Section 2 (INTERVIEWER’S USE ONLY):
Interviewers Names and Signatures
.......................................................................
......................................................................
.......................................................................
......................................................................
If candidate has answered ‘yes’ to either of the questions, please inform
Caroline Sargisson and forward all interview documentation to her.
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