PVG Self Declaration Form

Scottish Gymnastics Self Declaration Form for Regulated Roles with Children and/or Protected Adults
This form should be completed by the PVG applicant.

Scottish Gymnastics and its member clubs are committed to the safeguarding of children and protected adults involved in gymnastics and have a duty to ensure the suitability of any individual applying to work in a regulated role (paid or voluntary) with children or protected adults (or both).

Therefore, before you can be appointed, even to an unpaid position within your club, Scottish Gymnastics must check that you are suitable to do this type of work. You will be asked to become a Protection of Vulnerable Groups (PVG) Scheme member or gain an update to your PVG record if already a member of the scheme, and to make a self-declaration of any relevant convictions or investigations.
Applicant Name*

First NameLast Name
Club*
Role in Club*
Coach/helper, etc.
Under the Rehabilitation of Offenders Act (Exclusions and Exceptions) (Scotland) Amendment Order 2015 applicants are required to disclose any unspent convictions or cautions and any spent convictions for offences included in Schedule A1 ‘Offences which must always be disclosed’.

For more information, please check the documents below:

Offences which must be disclosed on a higher level disclosure

Applicants are not required to disclose spent convictions for offences included in schedule B1 ‘Offences which are to be disclosed subject to rules’ until such time as they are included in a higher level disclosure issued by Disclosure Scotland.

Offences which are disclosed subject to rules on higher level disclosure

Information provided is confidential. It will be managed according to our data protection policy and will not be shared outside of Scottish Gymnastics officials responsible for making safe appointment decisions.
Title*
Name*

First NameLast Name
Postal Address*
Contact Number*
Email*
example@example.com
Section 1 - Unspent convictions/cautions

These must be disclosed, as listed in the documents above.
1. Do you have any unspent convictions?*

YesNo
If yes, please give details
a) Please give the date and details of all the offence(s) with which you were charged, the sentence that you received and the court where your case(s) was heard. b) Please outline the circumstances that led to your offence(s). c) Please give details of the sentence imposed and how it was completed (for example paid fine as required) include information on conditions attached to your probation/community service/supervised attendance order.
2. Do you have any spent convictions for offences included in the list of offences which must always be disclosed on a higher level of disclosure?*

YesNo
If yes, please give details
a) Please give the date and details of all the offence(s) with which you were charged, the sentence that you received and the court where your case(s) was heard. b) Please outline the circumstances that led to your offence(s). c) Please give details of the sentence imposed and how it was completed (for example paid fine as required) include information on conditions attached to your probation/community service/supervised attendance order.
Section 2 - Details of any disciplinary action in relation to children and/or protected adults.
3. Have you been disciplined because of inappropriate behaviour towards a child or protected adult which may have harmed them or put them at risk of harm?*

YesNo
If yes, please give details
Section 3 – Relevant non-conviction information

Please note that this section does not require details of any spent alternatives to prosecution, e.g. police warnings or procurator fiscal warnings.
4.1 Do you have any relevant non-conviction information (including any police information)?*

YesNo
If you answered yes please give details of any investigations and outline the reasons and circumstances and disposal if known.
4.2 Are you, or have you ever been, known to any social work department/social services department as an actual or potential risk to children or protected adults?*

YesNo
If you answered yes please give details.
Section 4 – Other relevant information
Please give details of any other relevant information which you think we should be aware of when considering your application:
Section 5 – Protection of Vulnerable Groups (Scotland) Act 2007
Before signing the declaration below, please read the following notes on the Protection of Vulnerable Groups (Scotland) Act 2007 (PVG Act):

1. It is an offence to do, or to seek or agree to do any regulated roles (paid or unpaid) from which you are barred.

2. Section 35 of the same act makes it an offence for the club to offer regulated roles (paid or unpaid) to someone who is barred from that work.

3. A person is barred from regulated roles with children or protected adults if they are:

- The subject of an automatic listing (under section 14 of the PVG Act).

- Included on the PVG Children’s List and/or the Protected Adults list, and the Disclosure and Barring Service Children’s or Adults Lists which covers the rest of the UK.

- Considered for listing while information on their suitability is assessed.
Please choose the option which applies to you*

I confirm that I am not barred from regulated roles with children as set out in the PVG legislation, nor am I under consideration for listing as set out in the same Act.I am under consideration for listing for work with children.I confirm that I am not barred from regulated roles with protected adults as set out in the PVG legislation, nor am I under consideration for listing as set out in the same Act.I am under consideration for listing for work with protected adults.
Section 6 – Declaration
1. I hereby declare and represent that, except for as disclosed above, I have not at any time, whether in the United Kingdom or abroad, been found guilty and sentenced by a court for a criminal offence.

2. I will assist Scottish Gymnastics to request a scheme record/scheme record update (as appropriate under the PVG Act) for the purposes of verifying the replies given in this declaration, including enquiries of any relevant authority.

3. I agree to inform Scottish Gymnastics if I am convicted of an offence while a member of staff/volunteer. I understand that failure to do so may lead to the immediate suspension of my work (paid or unpaid) for the club and/or the termination of my services.

4. If I become considered for listing, I understand this will result in precautionary suspension.

5. I certify that all information contained in this form is true and correct to the best of my knowledge and realise that false information or omissions may lead to dismissal. I understand that deliberately giving false information can result in prosecution.
Signature*
Please type your full name to confirm the above statements
Date*

DayMonthYear
PVG & disclosures - Consent

I consent to the acquisition and sharing of PVG data between Scottish Gymnastics and my club in order to:-

1.     Permit the assessment of my suitability to be conducted by the club with the support, guidance and assistance of Scottish Gymnastics in making this determination for the purposes of the PVG legislation;

2.     Assist the club to take any steps in connection with my suitability assessment including advice in relation to the same; and

3.     Allow the club to share information in future when received in connection with any aspect of the PVG legislation.

I understand that I may withdraw my consent to the sharing and processing of information at any time. I acknowledge that if I do withdraw my consent it is likely that I will not be permitted to undertake regulated work or perform a regulated role.
Signature*
Please type your full name to confirm the above statements
Date*

DayMonthYear
Section 7 - Character references
Please also provide the name and contact details of two people (one being your present employer) who can provide a character reference. Both should not be related to you i.e. partner/husband/wife/sibling and they also should not be the person why submitted your application/ did your ID check.
Character Reference 1
Name*

First NameLast Name
Email*
example@example.com
Relationship to candidate*
Character Reference 2
Name*

First NameLast Name
Email*
example@example.com
Relationship to candidate*
Should be Empty:

Scottish Gymnastics Self Declaration Form for Regulated Roles with Children and/or Protected Adults

Section 1 - Unspent convictions/cautions

Section 2 - Details of any disciplinary action in relation to children and/or protected adults.

Section 3 – Relevant non-conviction information

Section 4 – Other relevant information

Section 5 – Protection of Vulnerable Groups (Scotland) Act 2007

Section 6 – Declaration

Section 7 - Character references

Character Reference 1

Character Reference 2