It is important that you read the 'Filtering rules for criminal record check certificates' in Appendix 1 before you complete this section of the form.

Filtering rules: As of 29 May 2013 you are no longer required to disclose information about any 'filtered' offences. Please see the guidance in Appendix 1 which sets out the Filtering rules for criminal record check certificates. You are not required to disclose on any part of this form any convictions or cautions that have been 'filtered'.

Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

Subject to the filtering rules failure to declare a conviction that you must disclose may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.

Section 1

Section 2

As an exception to the Rehabilitation of Offenders Act 1974, for certain roles and professions you are required to disclose all spent and unspent convictions. The DBS checks: eligibility guidance in Appendix 1 explains who is eligible for DBS checks but anyone doing such work must disclose spent and unspent convictions (subject to the filtering rules). If this is relevant to work that you are seeking please list all criminal convictions (spent and unspent) and their dates below, subject to the filtering rules.

Please include with this application a detailed CV or statement of support. This supporting statement should include a full history in chronological order since attaining your professional qualification. Please include details of all part-time and voluntary work as well as full time employment, with start and end dates, explanations for periods not in employment or education/training and reasons for leaving.

In line with the requirements of DfES guidelines (DfES/1568/2005 issued June 2005), I hereby confirm that all the information given on this form is correct to the best of my knowledge, that all the questions related to me have been fully and accurately answered, and that I am in possession of the Certificates I claim to hold. I am aware that providing false information is an offence, which may result in my application being rejected, summary dismissal and possible referral to the police.

Please choose one section from A to E and then tick the appropriate box to indicate your cultural background.