DBS Self Declaration & Consent Form

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1. Are you currently bound over, or do you have any current unspent convictions or cautions, or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or in any other country?
2. Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?
3. Are you aware of any current investigation being undertaken by the NHS Counter Fraud and Security Management Services (NHS CFSMS) following allegations made against you?
4. Have you been investigated by the Police, NHS CFSMS or any other Investigatory Body resulting in a current or past conviction or dismissal from your employment or volunteering position?
5. Have you ever been dismissed by reason of misconduct from any employment, volunteering, office or other position previously held by you?
6. Have you ever been disqualified from the practise of a profession, or required to practise subject to specified limitations following fitness to practise proceedings, by a regulatory or licensing body in the United Kingdom or in any other country?
7. Are you currently or have you ever been the subject of any investigation or fitness to practise proceedings by any Licensing or Regulatory Body in the United Kingdom or in any other country?
8. Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for the position for which you are applying?
9. Do you know of any other matters in your background which might cause your reliability or suitability for employment to be called into question?
DECLARATION IMPORTANT: The Data Protection Act 2018 requires us to advise you that we will be processing your personal data. Processing includes: holding, obtaining, recording, using, sharing and deleting information. The Data Protection Act 2018 defines 'sensitive personal data' as racial or ethnic origin, political opinions, religious or other beliefs, trade union membership, physical or mental health, sexual life, criminal offences, criminal convictions, criminal proceedings, disposal or sentence. Where you are applying for a position which involves regulated activity, this will also include any barring decisions made by the Disclosure and Barring Service (DBS) against the Children's or Adults Barred Lists under the terms of the Safeguarding Vulnerable Groups Act 2006 (as amended by the Protection of Freedom's Act 2012). The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 2018. It will be used for the purpose of determining your application for this position. It will also be used for purposes of enquiries in relation to the prevention and detection of fraud. Once a decision has been made concerning your appointment, Melody Care will not retain this declaration form any longer than necessary (see further details in 'Guidance Notes for Applicants' which was provided with your application form). This declaration will be kept securely and in confidence. Access to this information will be restricted to designated persons within the organisation who are authorised to view it as a necessary part of their work. In signing the declaration on this form, you are explicitly consenting for the data you provide to be processed in the manner described above. Please sign this form.
If you wish to withdraw your consent at any time after completing this declaration form or you have any enquiries relating to information required in this form, please contact the Recruitment Team on 01252 229360. All enquiries will be treated in strict confidence.