/ Return Address (SPOC Details)
Name: Chris Sutton
Senior Admin Officer
Address: 8th Floor West, Merrion House, 110 Merrion Centre, Leeds, West Yorkshire, LS2 8DT
Telephone: 0113 3952179
Force Disclosure Unit
PO BOX 9
Laburnam Road
Wakefield
WF1 3QZ

APPLICATION FOR POLICE CHECK ON AN INDIVIDUAL

Please undertake a check on your records of the person(s) named below for the reason stated.

Police information will not be disclosed unless there are important considerations of public interest to justify departure from the general rule of confidentiality. These considerations include the protection of vulnerable members of society. The information is provided on the strict understanding that it is for the use of the Social Care Team in preparing its reports and whilst the content can be discussed with the persons involved it must remain in control of the Social Care Team as it may contain 3rd party information.

SECTION 1 –REQUESTOR DETAILS

Case Reference Number
(Optional)
Social Worker
Local Authority/Council / Leeds City Council
Direct Telephone Number:
Fax Number
(Optional)

SECTION 2 – PURPOSE OF THE INFORMATION

Reason for Check
(Please tick one) / Placement with Parents Regulations
Pre-Birth Assessment
Court Report
Child with Child Protection Plan – Adult With Contact
Contact with Looked After Child
Emergency Placement of Child (these will be sent to CPPU)
Other (Please state reason below)
Name of Child (or children) Concerned in Check

SECTION 3 – DETAILS OF PERSON(S) TO BE CHECKED

Please fill all the below fields in either BLOCK CAPITALS or typed text

It is ESSENTIAL that names are spelt correctly and dates of birth are provided. Should any of the required fields not be completed, thorough Police checks cannot be conducted, which may result in vital information being missed. Incomplete forms will be returned and will not be processed until completed fully.

Adult Details 1
First Name:
Surname:
Previous Surname(s):
Date of Birth: / Gender:
Place of Birth:
Current Address:
Previous Address:
Relationship to Child:
Has This Persons Identity Been Checked: / Has Previous Information Been Supplied Regarding This Person:
Adult Details 2
First Name:
Surname:
Previous Surname(s):
Date of Birth: / Gender:
Place of Birth:
Current Address:
Previous Address:
Relationship to Child:
Has This Persons Identity Been Checked: / Has Previous Information Been Supplied Regarding This Person:

Yours Faithfully

Chris Sutton

Senior Admin Officer

Date: