About

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Your Name
Address
DfE/IFL Registered?
Emergency Contact Name:
£ 0
Is your DBS registered online?
Is your DBS - Child Checked?
Is your DBS - Adult Checked?
Do you have access to a car?
Do you have any holidays booked or are unavailable on certain days which you know about in advance?

BOTH UK & NON UK PASSPORT HOLDERS SHOULD ALSO FILL IN THE DETAILS BELOW:

Do you have a UK Passport?
Do you have a Biometric ID Card?
Do you have an Overseas Police Check?
Do you have the right to work in the UK?

UKBA Guidance

In line with UKBA guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by SENCare Recruitment Ltd for temporary work

REFERENCES

References will only be taken up with your knowledge and agreement. List present or most recent position first

Reference 1

Referee full name

Reference 2

Referee full name
Have you included a minimum of one work email for your references?
Have you asked permission first in the last 12 months from this person for a reference?
Selected Value: 0

MEDICAL QUESTIONNAIRE AND DECLARATION FORM

The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought.
Do you have any health issues or a disability relevant which may make it difficult for you to carry out functions which are essential for the role you seek?
If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment service and to attend interview, or to take aptitude tests etc?
Do you consider yourself medically fit for teaching/supporting in the UK?
I declare that all the answers to the above questions are true and complete to the best of my knowledge. I understand that any false statement or material omissions may lead to my removal from the register and/or refusal or any offer of work:

REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTION ORDER 1975)

Assignments will involve you in close contact with pupils under the age of 18 or with students with learning difficulties or disabilities; your registration with SENCare Recruitment Ltd is therefore exempt from the provisions of the Rehabilitation of Offenders Act 1974 and its supporting regulations. Consequently, you are NOT entitled to withhold information about convictions which for other purposes are “spent” under the Act. SENCare Recruitment Ltd will check the information given in this section with the relevant authorities. You will be required to apply for an enhanced disclosure level of police check through DBS (Disclosure & Barring Services).
Have you been convicted of a criminal offence other than a road traffic offence not involving injury to a 3rd Party, or a sentence of imprisonment?
Has anyone living in your household been barred from working with children by the DBS?
Has anyone living in your household been disqualified from working with children under the childcare Act 2006?

Employees living in a shared household

To the best of your knowledge, is anyone living at your address subject to the above?

Disqualification by Association

All employees are required to provide relevant information about a person who lives in the same household as them, who may have influence over the employee working with children and who may therefore pose a risk to children i.e. “by association”.
You are therefore required to disclose:
Details of any order, determination, conviction, or other ground for disqualification from registration under the Childcare (Disqualification) Regulations 2009. You are required to declare whether anyone living in your household is disqualified from working with children under the childcare Act 2006. This covers the following offences: offences against a child against an adult (e.g. rape, murder indecent assault, actual bodily harm etc.) The date of the order, determination or conviction, or the date when the other ground for disqualification arose; Information about the body or court which made the order, determination or conviction, and the sentence (if any) imposed; and A certified copy of the relevant order (in relation to an order or conviction).
Applicants Signature

Declaration

I confirm that the information I have declared above is correct and understand that I have duty to inform the Head teacher/Care manager should any of this information change at any time during my employment with the school.
Applicants Signature

Appendix A (to be read by all new employees)

A check as to the existence and content of any relevant criminal record will be requested from the Disclosure and Barring Service after a person has been selected for appointment. Refusal to agree to a check being made could disqualify you from being considered for the appointment.

Rehabilitation of Offenders Act 1974

Under the Rehabilitation of Offenders Act 1974, you have the right not to disclose details of ‘spent’ convictions. However, for certain jobs, employers are allowed to ask about these offences. The Rehabilitation of Offenders Act 1974 (Exception Amendment) Order 1986 sets out details of all jobs to which this applies and the job you have applied for is included in the list. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account.

FILTERING OF CAUTIONS AND CONVICTIONS

The filtering rules (which remove certain old and minor convictions and cautions, reprimands and warnings from a DBS Certificate) were developed by the Home Office and the Ministry of Justice and introduced with new legislation: The legislation is:
Police Act 1997 (Criminal Record Certificates: Relevant Matters) (Amendment) (England and Wales) Order 2013
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013

The Filtering Rules. For those 18 or over at the time of the offence:

An adult conviction will be removed from a DBS Certificate if,
11 years have elapsed since the date of conviction; and,
it is the person’s only offence, and
It did not result in a custodial sentence.
Even then, it will only be removed if it does not appear on the range of offences which will never be removed from a certificate, which include serious sexual and violent offences. (see Exceptions to the Rules). If a person has more than one offence, then details of all their convictions will always be included. An adult caution will be removed after six years have elapsed since the date of the caution – and if it does not appear on the list of offences relevant to safeguarding.

For those under 18 at the time of the offence:

For convictions, the same rules apply as for adult convictions, except that the elapsed time period is five and a half years. For cautions, the same rules apply as for adult cautions, except that the elapsed time period is two years.

Exceptions to the Rules

Some offences will never be removed from a DBS Certificate. These include the most serious sexual and violent offences. You can view this specified list of offences at:
www.gov.uk/government/publications/dbs-list-of-offences-that-will-never-be-filtered-from-a-criminal-record-check
Further information is also available from:- www.gov.uk/government/organisations/disclosure-and-barring-service
If you are unable to access the internet please contact the school who will be able to send this information to you direct.

You must provide details of any relevant criminal convictions that you may have. The disclosure of a criminal record may not necessarily prevent you from being appointed. The nature of the offence, how long ago it took place, your age at the time and any other relevant factors may be considered when a decision is made. Please note that some convictions are never considered ‘spent’ under the terms of the Act.

PROFESSIONAL MISCONDUCT

Have you ever been the subject of professional misconduct proceedings or suspensions from an employer, or such pending or threatened against you either in the UK or abroad?

OVERSEAS AND UK USE - DECLARATION

The information you provide will be checked. If you are found to have provided false information your application will be terminated and you will be offered no assignments through SENCare Recruitment Ltd. Further action may be taken.
I declare that all the information I have provided is accurate, complete and true.
Applicants Signature

ACCEPTANCE OF POLICY STATEMENTS & TERMS AND CONDITIONS

I have carefully read the Policy Statements published by and the Terms and Conditions and agree to be bound by them.
Applicants Signature

DATA PROTECTION STATEMENT

The information that you provide on this form and on any CV given will be used by SENCare Recruitment Ltd to provide you work finding services. In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients. We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other way permitted or required by law.
Applicants Signature

CANDIDATE DECLARATION

I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed onto potential employers. If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that SENCare Recruitment Ltd will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).
Applicants Signature

Bank Account Details (For PAYE Candidates)

SENCare Recruitment LTD - Registered Company Number: 12937860