Self Declaration form for a position requiring a Disclosure -- STRICTLY CONFIDENTIAL
As an organisation we undertake to meet the requirements of the Data Protection Act 1998 and all other relevant legislation, and the expectations of the Information Commissioners Office relating to the data privacy of individuals.


If you have never been convicted of a criminal offence or never received a caution, reprimand or warning then please select ‘No’ below. If you have been convicted of a criminal offence, or received a caution, reprimand or warning that is now spent according to DBS filtering rules*, then please select ‘No’ below.
If you have an unspent criminal offence, caution, reprimand or warning (according to DBS filtering rules*), please select ‘Yes’ below.
For exceptions to this legislation or for more information please refer to the Rehabilitation of Offenders Act 1974** and the DBS filtering guidance*.

Having read the above, do you have any unspent convictions; or are you at present the subject of a criminal investigation/pending prosecution? *
If yes, please give details.
Please give details including the nature of the offences and the dates. Please give details of the court(s) where your conviction (s) were heard, the type of offence and sentence(s) received. Could you also give details of the reasons and circumstances that led to the offence(s).
Your answer
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