Support Medical Group Application Form

The Rehabilitation of Offenders Act 1974 (Ammended)
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended)
The role you have applied for is exempt from the provisions normally afforded to individuals under the Rehabilitation of Offenders Act 1974. This means that the employer can obtain a standard or enhanced disclosure through the Disclosure and Barring Service (DBS) under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended) and, in certain circumstances, the Police Act 1997.

Enhanced disclosures may include other relevant non-conviction information held on police databases, at the discretion of the police or Chief Constable of the relevant police force.

Before you complete this form, it is important for you to read the highlighted note in the section below.

If you have a criminal record and are unsure about what might be revealed about you as part of a DBS check, or the type of information you should consider declaring when completing this form, the following links to guidance will help provide more clarity:

The simple guide to filtering (Unlock) at: http://hub.unlock.org.uk/knowledgebase/filtering-simple-guide/

Practical guidance on the DBS filtering rules (NACRO) at: http://www.nacro.org.uk/resettlement-advice-service/support-for-individuals/
Please provide details of the conviction or Summary Hearing including the date and sentence administered in the space below. Do you have any UNSPENT cautions, reprimands or final warnings as outlined in the Rehabilitation of Offenders Act 1974?This includes any unspent cautions, reprimands or final warnings that may have been issued in any other country, where it would be an equivalent offence in England and Wales. It also includes all unspent cautions that have been issued under military law while serving in the Armed Forces in the UK or any other country, where it would be an equivalent offence in England and Wales. You are not required to disclose any information in relation to cautions, reprimands or final warnings that have become SPENT. In these circumstances you should select NO to this question.*
Do you have any UNSPENT convictions as outlined in the Rehabilitation of Offenders Act 1974? This includes any unspent convictions that may have been issued in any other country, where it would be an equivalent offence in England and Wales. It also includes all unspent convictions or Summary Hearings that have been issued under military law while serving in the Armed Forces in the UK or any other country, where it would be an equivalent offence in England and Wales. You are not required to disclose any information in relation to convictions that have become SPENT. In these circumstances you should select NO to this question.*
Please provide details if YES
Do you have any convictions that are not protected (i.e. eligible for filtering) as outlined in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended) (the Exceptions Order)? It also includes all convictions or Summary Hearings that have been issued under military law while serving in the Armed Forces, either in the UK or any other country, where the equivalent offence in England and Wales is not protected. You are not required to disclose any information in relation to the above if ALL convictions are protected (i.e. eligible for filtering) as outlined in the Exceptions Order. In these circumstances you should select NO to this question. This requirement is regardless as to whether any conviction is spent or remains unspent.*
Please provide details if YES
Do you have any cautions, reprimands or final warnings that are not protected (i.e. eligible for filtering) as outlined in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended) (the Exceptions Order)? It also includes all cautions, reprimands or final warnings that have been issued under military law while serving in the Armed Forces, either in the UK or any other country, where the equivalent offence in England and Wales is not protected. You are not required to disclose any information in relation to the above if ALL convictions are protected (i.e. eligible for filtering) as outlined in the Exceptions Order. In these circumstances you should select NO to this question. This requirement is regardless as to whether any caution, reprimand or final warning is spent or remains unspent.*
Please provide details below if answered 'YES
Have you been dismissed from a NHS Trust or an Private Ambulance Service?*
Have you been dismissed from any other company or organisation (including Voluntary)?*
If you have answered yes to any of the above, please give details below.
Failure to declare or give information on questions answered will lead to your application being stopped or delayed.

Any additional Information that you think is important to the application.
Additional Information

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Volunteer Application

Reference

Equality and Diversity Monitoring

Disability