Have you ever been known to any Children’s Services YES / NO department or Police as being a risk or potential risk to (if Yes, provide information children? below): Have you been the subject of any disciplinary investigation YES / NO and/or sanction by any organisation due to concerns (if Yes, provide information your behaviour towards children? below): Confirmation of Declaration (tick box I agree that the information provided here may be processed in connection with recruitment purposes and I understand that an offer of employment may be withdrawn or disciplinary action may be taken if information is not disclosed by me and subsequently come to the organisation’s attention. In accordance with the organisation’s procedures if required I agree to provide a valid DBS certificate and consent to the organisation clarifying any information provided on the disclosure with the agencies providing it. I to inform the organisation within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or young people. I understand that the information contained on this form, the results of the DBS and information supplied by third parties may be supplied by the organisation to other persons or organisations in circumstances where this is considered necessary to safeguard children. Signature: name: Date:
Have you ever been known to any Children’s Services department or Police as being a risk or potential risk to children? YES / NO (if Yes, provide information below): Have you been the subject of any disciplinary investigation and/or sanction by any organisation due to concerns your behaviour towards children? YES / NO (if Yes, provide information below): Confirmation of Declaration (tick box I agree that the information provided here may be processed in connection with recruitment purposes and I understand that an offer of employment may be withdrawn or disciplinary action may be taken if information is not disclosed by me and subsequently come to the organisation’s attention. In accordance with the organisation’s procedures if required I agree to provide a valid DBS certificate and consent to the organisation clarifying any information provided on the disclosure with the agencies providing it. I to inform the organisation within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or young people. I understand that the information contained on this form, the results of the DBS and information supplied by third parties may be supplied by the organisation to other persons or organisations in circumstances where this is considered necessary to safeguard children. Signature: name: Date: