NEW - DBS DISCLOSURE IDENTIFICATION CHECKING FORM

ID checker:                                                   Company:

 

Applicant’s name          

 

 

………………………………................................                                         

Do they have any middle names?  

State here: 

 

....................................................    

Are they:

UK or EEA National ….. Non-UK / Non-EEA National ……………….

All documents must be in the applicant’s current name. At least one document must show the applicant’s current address.

At least one document must show the applicant’s date of birth.

Please ensure the details on the documentation you are shown  match those given on the Application form.

 

 

 

 

 

 

 

 

GROUP   1:    

 

                  (see Route Guidance Notes)

seen

Date of issue or date of letter /bill /certificate

Document number confirmed

Name confirmed

Date of birth confirmed

Current address confirmed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GROUP   2A:  

 

                  (see Route Guidance Notes)

seen

Date of issue or date of letter /bill /certificate

Document number confirmed

Name confirmed

Date of birth confirmed

Current address confirmed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GROUP   2 B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1)   Level of Disclosure suggested:      .           .           .           Enhanced ..........   Standard  ......….         

               (Wrighton Education Services reserves the right to suggest the most appropriate level of                    

               Disclosure if in our opinion too much/too little information is being sought for the post offered.)           

                                       

2)  a) Are you entitled to know whether the applicant is registered to work with children?                      YES / NO

     b) Are you entitled to know whether the applicant is registered to work with vulnerable adults?        YES / NO

     c) does the position involve working with children/vulnerable adults at the applicant’s home?        YES / NO

 

3)  Is this application for

            a) a new post holder, ................. b) an existing post holder,  ..........c) rechecking an existing post holder?..............

           

4)   Is this a voluntary post?            .              .              .              .              .              .              .              YES .......  / NO .......

 

What is a volunteer?  The definition of volunteering is ‘any activity that involves spending time, unpaid (except for travel and out-of-pocket

expenses) doing something which aims to benefit some third party (individuals or groups) other than or in addition to close relatives’.

Work experience is not considered voluntary.

 

4a)  Who is the third party who will benefit from the volunteering the applicant does whilst with your organisation?

                                          ..................................................................................................................................................................             

      

5)  Give a FULL description of how the applicant will be working with children and/or vulnerable adults.

The applicant will be ...........................................................................................................................................................

               ..............................................................................................................................................................................

6) Does the post involve regular contact with and /or accessing confidential information about:  

    A)  Children under 18 years            .              .              .              .              .              .              .            YES ....... / NO ....... 

    B) Vulnerable adults        .              .              .              .              .              .              .              .            YES ....... / NO .......

    B1)   Now tick the boxes below that apply to the Applicant’s post:

              

A vulnerable adult for the purposes of a Disclosure is a person aged 18 or over who receives services of a type listed in paragraph 1)

below and in consequence of a condition or disability of a type listed in paragraph 2) below,

 

1) The services are:-                                                                                                                                     * Tick one or more *

a)    accommodation and nursing or personal care in a care home

 

b)    personal care or support to live independently in his or her own home

 

c)    any services provided by an independent hospital, independent clinic,

                                                                                                 independent medical agency

       or National Health Service body

 

d)    social care services

 

e)    any services provided by an establishment catering for a person with learning difficulties

 

 

 

 

2) The conditions and disabilities are:-                                                                                                         * Tick one or more *

f)    a learning or physical disability

 

g)    a physical or mental illness, chronic or otherwise including an addiction to alcohol

                                                                                                                                 or drugs

 

h)    a reduction in physical or mental capacity

 

i)    a dependency on others in the performance of, or a requirement for the assistance in the

                                                                                   performance of, basic physical functions,

 

j)    severe impairment in the ability to communicate to others

 

k)    impairment in a person’s ability to protect him or herself from assault, abuse or neglect.

 

 

 

C) Any other occupation exempt form the Rehabilitation of Offenders Act 1974                                     YES ...... /   NO ......

                                                            (see the current list of exempt occupations on www.homeoffice.gov.uk/crb)

 

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ID checker’s Declaration

 

 I _______________________________________________(checker’s name)

 

of _______________________________________________ (company) have personally seen and checked

 

the original identity documents of ________________________________________________(applicant’s name).

 

Ÿ I confirm that the requisite documentation and information has been supplied and checked in accordance with

DBS guidance and DBS eligibility guidelines.

Ÿ I confirm that I have established the true identity of the applicant, by examining the requisite documents as set

out in the DBS guidance, and have verified the applicant’s title, full name, current address and date of birth.

Ÿ I declare that the information that I have provided in support of this application is complete and true and

understand that knowingly to make a false statement for this purpose may be a criminal offence.

Ÿ I certify that, where requested, an application for a DBS check is required for the purpose of asking an

exempted question under the terms of The Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975; or for

a prescribed purpose as defined in the Police Act 1997 (Criminal Records) Regulations 2002.

 

 Checker's

signature:                                                                                 

Date:

 

 

Please return this form with the Disclosure

 

Wrighton Education Services

43B Mason Street

London

SE17 1HF