DISC - Applicant Self Disclosure Form

At DISC, we are committed to safeguarding and promoting the welfare of all young people. We expect all staff, volunteers, and partners to share this commitment. As part of our safer recruitment practices, we follow rigorous procedures to ensure that all applicants are suitable to work with young people. This includes background checks, references, and adherence to our safeguarding policies. A copy of our Safeguarding Policy and Procedures will be shared alongside this form.

This self-disclosure form is for roles which are covered by the Rehabilitation of Offenders Act 1974 in England, Scotland and Wales or the Rehabilitation of Offenders (Northern Ireland) Order 1978. For completion by the person applying for the role.

Name of candidate/person

Previous name(s) if applicable

Please include date(s) each name was used (MM/YYYY)

Current Address

Street Address

Street Address Line 2

City

Post Code

Date you started living at this address (MM/YYYY)

Date From

Telephone/mobile number

Date of birth

Date

Gender

As the role you have applied for involves contact with vulnerable young people, you will also be required to undergo the relevant vetting and barring checks. Depending on the nature of the role, this could include checking criminal convictions and checking that you are not barred from working with children and young people. All information you provide will be treated as confidential and managed in accordance with relevant data protection legislation and guidance. You have a legal right to access any information held about you.

If yes, please provide further information

Have you ever been known to any Children's Services department or police as being a risk or potential risk to children/young people?

Have you been the subject of any investigation and/or sanction by any organisation or body due to concerns about your behaviour towards children/young people?

If yes, please provide further information and include details of the outcome

Have you ever been the subject of disciplinary sanctions or been asked to leave employment or voluntary activity due to inappropriate behaviour towards children/young people?

If yes, please provide further information

Do you have any unspent convictions in the UK or overseas?

If yes, please provide further information

Confirmation of declaration (tick box below)

I agree that the information provided here may be processed in connection with recruitment purposes and I understand that an offer of employment may be withdrawn or disciplinary action may be taken if information is not disclosed by me and subsequently come to the organisation's attention.

In accordance with the organisation's procedures if required I agree to provide a valid criminal record certificate and consent to the organisation clarifying any information provided on the disclosure with the agencies providing it.

I agree to inform the organisation within 24 hours if am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or young people.

I understand that the information contained on this form, the results of the criminal record check and information supplied by third parties may be supplied by the organisation to other persons or organisations in circumstances where this is considered necessary to safeguard

Signature of candidate

Print name

Date