Self- Declaration & Disclosure Form Updated January 2018. Private and Confidential For roles involving contact with children (under 18 year olds). All information will be treated as confidential and managed in accordance with relevant data protection legislation and guidance. You have a right of access to information held on you under the Data Protection Act 1998. Part One For completion by the organisation: Name: Address and Postcode: Telephone/Mobile No: Date of Birth: Gender: Male / Female Identification (tick box below): I confirm that I have seen identification documents relating to this person, and I confirm to the best of my ability that are accurate. Either UK Passport Number and Issuing Office UK Driving Licence Number (with picture) Plus National Insurance Card or current Work Permit Number Signature of authorised Employing Officer: name: Date:
Self- Declaration & Disclosure Form Updated January 2018. Private and Confidential For roles involving contact with children (under 18 year olds). All information will be treated as confidential and managed in accordance with relevant data protection legislation and guidance. You have a right of access to information held on you under the Data Protection Act 1998. Part One For completion by the organisation: Name: Address and Postcode: Telephone/Mobile No: Date of Birth: Gender: Male / Female Identification (tick box below): I confirm that I have seen identification documents relating to this person, and I confirm to the best of my ability that are accurate. Either UK Passport Number and Issuing Office UK Driving Licence Number (with picture) Plus National Insurance Card or current Work Permit Number Signature of authorised Employing Officer: name: Date:
self-declaration-jan-18.docx