In Strict Confidence

In Strict Confidence:- Teesside University is requesting this information as part of the recruitment process to ensure candidates are fit for practice. ALL OFFERS OF A PLACE ON OUR PROGRAMMES ARE SUBJECT TO CERTAIN CONDITIONS, ONE OF WHICH IS AN ENHANCED DISCLOSURE WHICH WILL BE PROCESSED THROUGH THE DISCLOSURE AND BARRING SERVICE (DBS). THE ATTACHED INFORMATION SHEET EXPLAINS IN MORE DETAIL. PLEASE READ THIS BEFORE COMPLETING THIS FORM.

IT IS IN YOUR INTEREST TO DECLARE ANY CONVICTIONS, CAUTIONS, REPRIMANDS OR FINAL WARNINGS WHICH WOULD NOT BE FILTERED IN LINE WITH CURRENT GUIDANCE AS DEFINED BY THE REHABILITATION OF OFFENDERS ACT 1974(EXCEPTIONS) ORDER 1975 (AS AMENDED IN 2013) BY SI 2013 1198). THE DBS FILTERING GUIDANCE IS AVAILABLE ON THEIR WEBSITE AT WWW. GOV. UK/GOVERNMENT/PULICATIONS/DBS-FILTERING- GUIDANCE. DO YOU HAVE ANY CONVICTIONS, CAUTIONS, REPRIMANDS OR FINAL WARNINGS, WHICH WOULD NOT BE FILTERED IN LINE WITH CURRENT GUIDANCE?

(PLEASE TICK ONE BOX) YES ? NO ? IF YOUR ANSWER IS YES PLEASE GIVE DETAILS BELOW: Please complete and sign the reverse of this form DATE MOST RECENT 1ST NATURE OF OFFENCE/CONVICTION/ ALLEGATION/INVESTIGATION OUTCOME E. G. FINE/CAUTION ETC. Form Updated 07 November 2013 HAVE YOU BEEN INVOLVED IN A CHILD/ADULT WELFARE ISSUE PLEASE (TICK ONE BOX) YES ? NO ? ARE YOU ON A DBS BARRED LIST EITHER DBS CHILDREN’S BARRED LIST OR DBS ADULTS BARRED LIST IF SO PLEASE ADVISE WHICH AND PROVIDE DETAILS.

SIGNED PRINT NAME DATE UCAS ID NO PROGRAMME APPLIED FOR DATE OF BIRTH ADDRESS NB: This information will be kept strictly confidential. If an offer is not made this information will be destroyed and no reference made to it. Acceptance on to the programme does not automatically guarantee Professional Registration. All offers made are conditional, when your enhanced disclosure has been processed by the Disclosure and Barring Service you may be asked to attend a recall interview.