Rehabilitation of Offenders Act 1975 (Exceptions) Order Do you have any criminal convictions or cautions (The post for which you are applying requires contact with vulnerable adults and children, Yes No you are therefore required to reveal any criminal convictions or cautions, including those which would normally be regarded as spent) If yes, please give details / dates of offence(s) and sentence: Please note that a disclosure from the Criminal Records Bureau will also be required and if you are successful you will be to complete a disclosure application. Failure to declare a conviction or caution at this stage will result in summary dismissal from this position. References Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are. Name: Name: Position Position (job title): (job title): Work Work Relationship: Relationship: Organisation: Organisation: Address: Address: Postcode Postcode Telephone No Telephone No E-mail: E-mail: Are you willing for this Are you willing for this referee to be approached Yes No referee to be approached Yes No prior to the interview? prior to the interview?
Rehabilitation of Offenders Act 1975 (Exceptions) Order Do you have any criminal convictions or cautions (The post for which you are applying requires contact with vulnerable adults and children, you are therefore required to reveal any criminal convictions or cautions, including those which would normally be regarded as spent) Yes No If yes, please give details / dates of offence(s) and sentence: Please note that a disclosure from the Criminal Records Bureau will also be required and if you are successful you will be to complete a disclosure application. Failure to declare a conviction or caution at this stage will result in summary dismissal from this position. References Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are. Name: Name: Position (job title): Position (job title): Work Relationship: Work Relationship: Organisation: Organisation: Address: Address: Postcode Postcode Telephone No Telephone No E-mail: E-mail: Are you willing for this referee to be approached prior to the interview? Yes No Are you willing for this referee to be approached prior to the interview? Yes No