Self-Disclosure

Step 1 of 3

Congratulations on being shortlisted. Please return this disclosure to us at least one day prior to interview. If we have not received this, we reserve the right to withdraw the offer of interview.

Position applied for(Required)

Date(Required)

Name(Required)

Forename(s) Surname

Any / all previous name(s)

Preferred title(Required)

What is your date of birth?(Required)

National Insurance Number(Required)

Teacher Ref. No (if applicable): *Or HCPC registration number, etc

Date of recognition as qualified teacher, QTS (if applicable)

Please complete the declarations below:

I declare that all the information I have provided in this disclosure is full and correct at the time of application and that I have not omitted anything that could be relevant to the appointment of someone who will work with children and / or vulnerable adults. I understand that the recruitment panel may be made aware of any relevant information that I have disclosed in order to discuss the matter(s) with me as part of the recruitment process and that, if my application is successful, a risk assessment of the disclosed information will be held securely on my personnel file. I understand that the declaration of a criminal record will not necessarily prevent me from being offered this role.

Signature(Required)

Date(Required)

If my application is successful, I give my consent to Overley Hall Limited to request an Enhanced DBS certificate, including a check of the relevant barred list(s) if the role will be in regulated activity with children and / or adults, and to requesting references for the purposes of verifying the replies given in this declaration, including enquiries of any relevant authority.

I agree to inform Overley Hall Limited if I am convicted of any offence after I take up any post within the organisation. I understand that failure to do so may lead to the immediate suspension of my work with vulnerable adults or children with the organisation and/or the termination of my services.

If I am appointed to a post, I agree to abide by the organisation’s Policy on the Protection of Vulnerable Adults and Child Protection Policy.

I agree to abide by the conditions above and certify that the information contained in this form is true and correct to the best of my knowledge and I realise that false information or wilful omissions may lead to the immediate suspension of my work with children or the termination of my services.

Signature(Required)

Date(Required)

Please note that, if you are unsuccessful, this disclosure form will be securely destroyed 6 months from the date of interview.

*Applicants for management posts in the school only

Please complete the declarations below: