CHECK ON CONVICTIONS OR CAUTIONS A check as to the existence and content of a criminal record may be requested from the Disclosure and Barring Services (DBS) after a person has been selected for appointment to this post. Refusal to agree to a check being made could disqualify you from being considered for the appointment. You are therefore asked to sign the statement below to confirm your agreement, if you are selected for the appointment, to a check being made on any criminal record applicable to you. Under the Rehabilitation of Offenders Act 1974, you have the right not to disclose details of ‘spent’ convictions. However, for certain jobs, employers are allowed to ask about these offences. The Rehabilitation of Offenders Act 1974 (Exception) (Amendment) Order 1986 sets out details of all jobs to which this applies and the job you have applied for is included in that list. Please give details of ALL convictions, cautions, reprimands or warnings (whether spent or not). Disclosure and Barring Services The Disclosure and Barring Services (DBS), an executive agency of the Home Office, helps employers check records which were previously held by the police, the Department of Health and the Department for Education and Employment. Different levels of disclosure can be provided, according to the type of work applied for. The job for you have applied will necessitate an Enhanced disclosure STANDARD DISCLOSURE These are for positions that involve regular contact with children or vulnerable adults. They contain details of all convictions, cautions, reprimands or warnings on record. ENHANCED DISCLOSURE These are for positions with greater contact with children or vulnerable adults, like social workers and doctors, for example. They involve an extra level of checking. PREVIOUS CHECKS If a has been previously carried out for you, please provide the name of the local authority who undertook it, the outcome and the date it was carried out. It is not sufficient to give the name of an employment agency (if applicable). If you have a letter giving the result, please attach a copy.
OPPORTUNITIES MONITORING FORM Post Applied For Ref No. Surname or Family Name Former Name(s) names Do you consider yourself to have a disability? (i.e. a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities) (Delete as appropriate) Yes / No If you have a disability what equipment, adaptations or adjustments to working conditions would assist you in carrying out your duties? What is your gender? (Delete as appropriate) Female / Male Which of the following best describes your Ethnic origin? These categories are based on the 2001 census. Your answer must be within this list: White - British / White - Irish / White - Other / Mixed - White & Black Caribbean / Mixed - White & Black African / Mixed - White & Asian / Mixed - Other Mixed Group / Asian or Asian British - Indian / Asian or Asian British - Bangladeshi / Asian or Asian British - Pakistani / Asian or Asian British - Other Asian / Black or Black British - Caribbean / Black or Black British - African / Black or Black British - Other Black background / Chinese / Any other ethnic group