Emergency Contact Details

Education Details - (E.g. GCSE, O-Level, A-Level, NVQ, or Equivalent)

Further Education (E.g. Degree / Diploma / Certificate)

Professional Qualifications (E.g. Nursing, Allied Health Professional, Social Care, Administration Management)

Employment History – Present Post

INFORMATION KNOWINGLY OR WILFULLY WITHELD TO OBTAIN EMPLOYMENT WILL RESULT IN SUMMARY DISMISSAL

N.B:  Any information knowingly or wilfully withheld will result in termination of contract. 

Staff Pre-Employment Vetting Check

In order to protect the public this post is exempt from Article 5 of the Rehabilitation of Offenders (Northern Ireland) Order 1978, and the Rehabilitation of Offenders (Exceptions) (Northern Ireland) Order 1979 and requires that all convictions and cautions must be declared, and that no conviction or caution can be deemed to be spent 

For the purposes of this employment all Job Applicants are required to undergo a Pre-Employment enhanced Vetting Check conducted by Access NI, which shall confirm any criminal history or otherwise of each Applicant.

The cost for each enhanced Vetting Check is £33.00, payment of which is the responsibility of the Applicant.

Further details on Access NI and their code of practice can be accessed on www.nidirect.gov.uk/accessni

By signature herewith I confirm that I have completed and signed the Access NI Application form for an Enhanced Check, which has been explained to me, and I understand that no offer of substantive employment will be made to me until the Access NI Pre-Employment Enhancement Vetting Check is satisfactorily completed.

The following policies are available on request

• Policy on Access NI Security

• Policy Statement on Recruitment of ex-offenders

Independent Safeguarding Authority

Policy & Disclosure of Criminal Convictions Form

PRIVATE & CONFIDENTIAL

Please complete this disclosure form as accurately as possible and place in the confidential envelope provided. The information will not be discussed at the interview itself. A separate arrangement will be made with you if clarification is required.

You have applied for a post which is a Regulated Position as defined by the Protection of Children & Vulnerable Adults (NI) Order 2003 and also falls within the definition of an “excepted” position as provided by the Rehabilitation of Offenders (Exceptions) Order (NI) 1979: Therefore ALL convictions MUST be disclosed.  

Having a conviction will not necessarily debar your Application from being considered.  This information will be verified through the appropriate Access NI enhanced check.  If you have received a formal caution or are currently facing prosecution for a criminal offence, you should also bring this to our attention given the “excepted” nature of the post.

Please provide any other information you feel may be of relevant such as:

• The circumstances of the offence

• A comment on the sentence received

• Any relevant developments in your situation since then

• Whether or not you feel the conviction has relevance to this post

I Declare that any information I have given are complete and correct to the best of my knowledge.