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Declaration of Criminal Background Form

This document is a declaration form for health sciences students regarding their criminal background, necessary for their future roles in treating vulnerable populations. Students must disclose any ongoing investigations, convictions, or cautions, and are informed about the filtering of certain spent convictions. The form requires personal details and a declaration of truthfulness, along with a commitment to notify the admissions team of any changes before the start of studies.

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21 views1 page

Declaration of Criminal Background Form

This document is a declaration form for health sciences students regarding their criminal background, necessary for their future roles in treating vulnerable populations. Students must disclose any ongoing investigations, convictions, or cautions, and are informed about the filtering of certain spent convictions. The form requires personal details and a declaration of truthfulness, along with a commitment to notify the admissions team of any changes before the start of studies.

Uploaded by

gouda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

FACULTY OF HEALTH & LIFE SCIENCES

SCHOOL OF HEALTH SCIENCES


DECLARATION OF CRIMINAL BACKGROUND

You will understand that as a health sciences student, and when you qualify, you will be expected to treat
children and other vulnerable people. We therefore require information about any criminal offences of which
you may have been convicted, where there is an ongoing investigation or with which you have been charged.
The information you provide may later be checked with the police.

(PLEASE PRINT CLEARLY USING BLOCK CAPITALS)

Surname ………………………………………………………………………………….Title…………………………..

Forenames ………………………………………………………………………………………………………………...

Maiden name or other names by which you have been know.............................................................................

Present Address…………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………

…………………………………………………………………… Post Code…………………....................................

Email Address (not School/College)..........................................................................................................................

Contact telephone Number...................................................................

Date of Birth…………………………………………………. Country of Birth..........................................................

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions
are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance
and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring
Service website [Link]

Do you have any on-going investigations, convictions, cautions, reprimands or final warnings, which would
not be filtered in line with current guidance? YES/NO (please ensure you delete as appropriate)

If YES, please provide full details on the reverse about the nature of the on-going investigation, offence, date
of conviction or caution and the sentence.

I declare that the statements made and information given on this document are true to the best of my
knowledge and belief.

I declare that should anything disclosed on this form change from the date of completion to the date
of commencement of studies I will notify the Admissions Team at shs@[Link] or tel: 0151
795 6000 immediately.

Signed…………………………………………………….. Date…………………………………………….

Programme applied
for.........................................................................................................................

UCAS Personal ID No………………………………………………………………………………………...

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