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Exeter Staff Suitability Form

Exeter Suitability Form

"*" indicates required fields

First Name*

Surname*

Pronouns*

For example: (She/her, his/him, they/them)

Have you been known by any other names?*

Yes / No, If yes please detail the changes.

Date of Birth*

DD slash MM slash YYYY

Were you born in the UK?*

If Yes, have you stayed in any other countries for 3 months+*

If Yes, please can you specify which Country

If No, Country of origin? (You need to provide a Certificate of Good Conduct (COGC) from Country of Origin)*

Arrival date in the UK*

MM slash DD slash YYYY

Tops Day Nurseries is committed to safeguarding and promoting the welfare of children and we expect all staff to share this commitment. This post is exempt from the Rehabilitation of Offenders Act 1974; pre-employment checks will be carried out, references will be sought and successful candidates will be subject to an enhanced DBS check and other relevant checks with statutory bodies.

We comply with the Disclosure & Barring Service (DBS) code of practice and have a written policy on the recruitment of ex-offenders, both of which are available on request. As you have been shortlisted, you are required to declare any relevant convictions, adult cautions or other matters which may affect your suitability to work with children. As a result of amendments to the Rehabilitation of Offenders Act 1974 (exceptions order 1975) in 2013 and 2020, some minor offences are now protected (filtered) and should not be disclosed to potential employers, and employers cannot take these offences into account.

Please read carefully before answering the following questions. If you are unsure whether you need to disclose criminal information, you should seek legal advice or you may wish to contact Nacro or Unlock for impartial advice. There is more information on filtering and protected offences on the Ministry of Justice website. Nacro - https://www.nacro.org.uk/criminal-record-support-service/ or email helpline@nacro.org.uk or phone 0300 123 1999 Unlock – http://hub.unlock.org.uk/contact/ phone 01634 247350 text 07824 113848

Do you have any convictions or adult cautions that are unspent?*

If yes, please provide details here*

Do you have any other cautions or convictions that would not be filtered?*

If yes, please provide details here*

Do you have any cautions or convictions for offences committed in another country which would be relevant to your suitability for this post in line with the law in England / Wales?*

If yes, please provide details here*

Are you known to the police or children’s social care for any other reason that could affect your suitability for this post?*

If yes, please provide details here*

Have you found to have committed a relevant offence against a child?*

If yes, please provide details here*

Made subject to an order or determination removing a child from your care or preventing a child from living with you?*

If yes, please provide details here*

Found to have committed certain offences against an adult; for example, murder, kidnapping, rape, indecent assault, or assault causing actual bodily harm?*

If yes, please provide details here*

Included on the list of those who are barred from working with children, held by the Disclosure and Barring Service*

If yes, please provide details here*

Made the subject of a disqualifying order?*

If yes, please provide details here*

Previously refused registration as a childcarer or have had registration cancelled, unless the cancellation was only for non-payment of fees for continued registration after 1 September 2008*

If yes, please provide details here*

Refused registration as a provider or manager of children’s homes or have had registration cancelled.*

If yes, please provide details here*

Are you included on the DBS children’s barred list?*

If yes, please provide details here*

Have you lived or worked outside the UK for more than 3 months in the last 5 years?*

If yes, please provide details here*

Are you subject to any sanctions relating to work with children in any country outside the UK?*

If yes, please provide details here*

Consent*

I declare that all the information I have provided in this disclosure is full and correct at the time of application and that I have not omitted anything that could be relevant to the appointment of someone who will work with children. I understand that the recruitment panel may be made aware of any relevant information that I have disclosed in order to discuss the matter(s) with me as part of the recruitment process and that, if my application is successful, a risk assessment of the disclosed information will be held securely on my personnel file. I understand that the declaration of a criminal record will not necessarily prevent me from being offered this role.

Marketing*

By providing your email, you agree to receive communications from us for marketing purposes and other career opportunities. If you wish to opt out of these communications, please tick the box.

Name Printed*

Name Signed*

Date*

MM slash DD slash YYYY

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Registered address: 3 Wollaston Road, Southbourne, Dorset, BH6 4AR
59961744

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