1. Have you ever been convicted by the courts or cautioned, reprimanded, or given a final warning by the police? Please give details of offences, penalties and dates in the table below. *(Note that the post you have applied for is exempted under the Rehabilitation of Offenders Act (Exceptions Order) 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed.

2. Have you ever been disqualified from work with vulnerable adults or sanctions imposed by any regulatory body?

3. Please sign the following declaration and return this form to Human Resources with your application. Failure to complete this declaration will result in your application being withdrawn.

13 + 10 =