Confidential Declaration - Self Disclosure

This form must be completed by everyone wishing to work with children, young people or vulnerable adults (in voluntary or paid roles). This form will be held confidentially and securely by the church in line with the Data Protection Act 1998. You have a right to access information held about you in line with the Data Protection Act 1998

 

Full Name (including middle names):

Have you been known by any other names?
Date of Birth
Sex
Do you have any convictions, cautions, reprimands or final warnings that are not 'protected' as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended 2013)?
For helpful information about which offences need to be declared see: https://www.gov.uk/government/publications/dbs-filtering-guidance/dbs-filtering-guide
Yes   
No    

Please give details below
Have you ever been known to any local authority children or adult safeguarding team, or the police as being a risk or potential risk to children, young people or vulnerable adults?
Yes 
No  
Please give details below

Have you ever been subject of an investigation by any organisation or body due to concerns about you behaviour towards children or vulnerable adults?
Yes  
No    
Please give details below

Confirmation of Declaration
I agree that the information provided here may be processed for recruitment purposes (both to employed and voluntary posts). I understand that the offer of employment or voluntary work could be withdrawn if information is not disclosed by me and subsequently comes to the church's attention.
Yes     

In accordance with the church's safeguarding policy and procedures, I will provide a valid DBS certificate and consent to the Baptist Union of Great Britain (the church's overarching support organisation), on behalf of the church, clarifying any information provided on it with the agencies providing it.
Yes     

I will inform the church within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children, young people or vulnerable adults.
Yes    

I understand that the information in this form, the results of the DBS check and information supplied by third parties may be passed to other persons or organisations in circumstances where this is considered necessary to safeguard children, young people or adults at risk.

Name    

Date of declaration   

Once completed, a copy of the data submitted in this form will be presented to you by the safeguarding administrator for signature to confirm that the submission is accurate.

This form will be accessed if a concern is raised about your suitability for the position applied e.g. a blemished DBS disclosure