Final Good Character Checks

00922: Fee-paid Medical Member of the First-tier Tribunal, Health, Education and Social Care Chamber (Mental Health)

Final Good Character Checks

Consent form for candidates applying for judicial appointments

Please refer to the good character guidance on the JAC website to see how this information will be used.

Please complete, sign and date all sections of this form

Section A

Personal Information

Title ……………………………………………………………………………………………

Surname ………………………………………………………………………………………

Full forenames ……………………………………………………………………………….

Previous Name/Any Other Names Used (if applicable) …………………………………

Gender ………………………………………………………………………………………..

Date of Birth …………………………………………………………………………………..

Place of Birth …………………………………………………………………………………...

Address ………………………………………………………………………………………..

………………………………………………………………………………………..

Postcode ……………………………………………………………………………………….

National Insurance Number ………………………………………………………………….

Nationality ………………………………………………………………………………

Occupation ……………………………………………………………………………..

Section B

Professional Body Checks

(If a Barrister) – Bar Membership Number ………………………………………….

(if a Solicitor) – Solicitors Regulation Authority Number …………………………...

I consent to such persons and/or professional bodies as may be required for the purposes of my application disclosing to the JAC, in strict confidence, information relating to my conduct and professional reputation, including :

(a)the disclosure of the details of any complaints upheld (relating to professional misconduct or inadequate professional service).

Yes / No

(b)the disclosure of the details of any outstanding complaints that have not yet been determined or resolved relating to professional misconduct or inadequate professional service.

Yes / No

Signature ………………………………………… Date ……………………………………..

Section C

HMRC Checks

VAT registration number ………………………………………………………………

Tax district and reference number ……………………………………………………

I consent to HM Revenue and Customs (HMRC) disclosing to the Judicial Appointments Commission (JAC) in strict confidence, any information regarding the following, whether or not held on a computer system, and including where I act as trustee or personal representative:

(a)disclosing details of any outstanding, or late submitted, personal returns of tax or duties and penalties or surcharges raised thereon:

Yes / No

(b)disclosing details of any outstanding debts of personal tax or duties and time to pay arrangements:

Yes / No

(c)disclosing details of any on-going enquiry into my personal returns of tax or duties:

Yes / No

(d)where I am a partner, disclosing whether there is any on going enquiry into a partnership return of tax or duties:

Yes / No

(e)disclosing details of any record relating to HMRC Border controls in regard to departure and arrivals in the UK, for example, excise, prohibitions and restrictions:

Yes / No

Signature ………………………………………… Date ……………………………………..

Section D

Criminal Checks

Previous Address (if moved within last 5 years) ……………………………………......

………………………………………………………………………………….

Postcode ……………………………………………………………………………………….

National Insurance Number ………………………………………………………………….

Nationality ………………………………………………………………………………

Occupation ……………………………………………………………………………..

I further consent that the College of Policing (formerly the Association of Chief Police Officers) may, in strict confidence, disclose to the JAC any offence of which I have been convicted in relation to a criminal matter or infringement of the law and any caution administered to me at any time, unless the conviction, infringement or caution falls to be disregarded under the terms of the Rehabilitation of Offenders Act 1974.

Signature ………………………………………… Date ……………………………………..

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