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Information for students and sponsors
Name (please print your full name here)
When you have completed this form, please check the details, sign and date it and pass to your sponsor for them to complete Section 7. Your sponsor (known to us as ‘agency co-ordinator’ and usually someone who has responsibility for training and development within the organisation) will be asked to return the form (if you prefer in a separate envelope marked Confidential) alongside your application form to:
The Social Work Admissions Manager
Faculty of Wellbeing, Education & Language Studies
School of Health, Wellbeing & Social Care
The Open University
Milton Keynes,
MK7 6AA
Email:
Tel: 01908 654229
1 Introduction
It is important that social work programme providers ensure that those who embark upon professional training are suitable to do so. To this effect, applicants will need to undergo the following checks:
a) enhanced checks by the Disclosure and Barring Service (DBS); and
b) confirmation that any health condition they experience is not likely to impact upon their ability to practice safely.
In addition to these statutory requirements The Open University (OU) requires you to complete this declaration to help us make a well-informed judgement about your ability to enter social work training.
When you complete your social work qualification you will be eligible to apply to register with the Health and Care Professions Council (HCPC) and then, if registered, practice as a social worker. While the OU is making a prospective judgement as to your suitability to train as a social worker, the HCPC ultimately makes the decision whether you are suitable for entry on the register upon application at the end of your studies.
Please note that the OU does not automatically exclude students who have a criminal or disciplinary record, or have previously experienced poor health, or have had contact with social service departments. We recognise that in many in instances, there is no simple criterion of suitability and therefore each case will be assessed individually. You will be informed if your declaration is thought to require further consideration, and in the event that this results in an offer not being made or your offer being withdrawn, you will be informed of the general reason (subject to any restrictions on passing on confidential information contained within the Data Protection Act 1998).
Please read and complete the following sections carefully. If you are unsure how to proceed or have any queries, contact the Social Work Admissions Manager who will advise you. The information you provide will be treated as confidential.
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2 Criminal convictions and legal records
Please tick yes or no for each question:YesNo
Have you ever been convicted of any offence by any court regardless of age?Have you ever been cautioned?
Have you ever been reprimanded?
Have you ever been bound over?
Do you have any prosecutions pending?
Have you ever been disqualified from working with children by an order under the Criminal Justice and Court Services Act (2000)?
Have you ever received a fixed penalty notice (excluding those for speeding)?
If you have answered 'yes' to any of these questions, please give full details (date, court, offence, outcome, conviction, sentence, etc.). Please note that it is very important that you provide as much detail as possible. Failure to do so may delay your application. You may use a separate sheet if necessary.
Please tell us why you think you were involved in the incident/s and what you have learned since that time. In particular, please write about what you have learned since that time that will make it unlikely that anything similar would happen now.
3 Disciplinary record, unprofessional conduct, and notifiable listings
Social service agencies and members of the public who receive services are entitled to expect the highest standards of reliability and integrity from social workers and it is imperative that the qualifying award is held only by those whose personal and professional conduct merits this trust. The OU requires that you make a declaration in this regard.
Please tick yes or no for each question:YesNo
Are you currently the subject of any disciplinary investigation?Have you ever been the subject of any disciplinary investigation (regardless of outcome)?
Have you ever had your employment suspended or terminated for unprofessional behaviour or misconduct?
Have you ever been suspended or disqualified from a social work or any other professional training programme or professional register?
Have you ever received a final warning?
Have you ever been barred under either the Protection of Vulnerable Groups Act 2006 and / or the Protection of Vulnerable Groups (Scotland) Act 2007 from working with children or vulnerable adults? Or have you been listed upon the Protection of Vulnerable Adults (POVA) register, the Protection of Children Act list (POCA) and Section 142 of the Education Act 2000 (formerly List 99)?
Have you previously enrolled upon a social work training programme?
If you have answered 'yes' to any of these questions, please provide as much information as possible in the box below. If you have ever been registered on another social work programme please include details of dates of study, name of institution and reason for leaving. You may use a separate sheet if necessary.
4 Personal health and circumstances
Social work is a demanding and sometimes stressful occupation and the practice of social work is often undertaken with people who are vulnerable, at risk, or whose capacity to manage their own affairs is temporarily or permanently impaired. Accordingly, the programme seeks to ensure that all students are willing and able to identify and manage their own needs in a way that avoids any risk to the safety of service users, or to themselves.
We need to know whether you have been subject to any statutory order under the Mental Health Act 1983. We also need to know if you have ever been involved in a child protection investigation, court proceedings regarding child welfare issues, had children in your personal care placed upon a child protection register or placed in care or have lived in a household where children have been registered or placed in care.
Please note that we do not require information about any health condition unless it affects your capacity to study or your fitness to practice. As part of the application process your employer’s Occupational Health or Human Resources Department will be asked to sign a form confirming your medical fitness to practice. For small organisations which are unable to undertake their own checks we will provide you with a medical questionnaire which will remain confidential and will be checked by a private company.
Please tick yes or no for each question:YesNo
Do you have any physical or mental health condition that in the normal course of your social work duties might present a direct risk to other people, or which might affect your judgement or performance in a way that poses risk to others?Have any child/ren in your care, or the household in which you live/d, been placed upon a child protection register/subject to a child protection plan or placed in care?
Have any child/ren in your care, or in the household in which you live/d, been subject of court proceedings regarding their welfare?
If you have answered 'yes' to any of these questions, please give full details in the box below. You may use a separate sheet if necessary.
5 Disability
Disability need not be a barrier to training and qualification and in accordance with the provisions of the Disability Discrimination Act (2005) and the Equality Act 2010 the University will make ‘reasonable adjustments’ to meet your personal requirements. Please note that for the purposes of this declaration you do not need to make any statement about your disability. If you do wish to discuss what adjustments might be required, you may do this informally prior to interview, or may wait until after the results of your interview have been communicated to you. Once you are registered on the programme you will have the opportunity to discuss your requirements and what adjustments and arrangements may be necessary. If you have any further enquiries or concerns in regard to disability please contact the Social Work Admissions Manager directly or the University’s Services for Disabled Students at
6 Your declaration
I understand that the information that I have provided will be checked against my Enhanced Disclosure and Barring Service (or successor bodies) disclosure and that my signature affirms that this is a full and accurate declaration.
I understand that if I refuse to provide additional relevant information or otherwise assist in this suitability process that any provisional offer of a place on the programme may be withdrawn.
I also understand that failure to disclose relevant information is regarded as a serious matter and that if it is discovered after I have been accepted on the programme, it could result in a suitability investigation which may lead to exclusion from training.
I agree to notify the OU promptly with any new information that may impact on my suitability for social work training during my time on the programme.
I agree that the information that I give may be used to assess my suitability for social work training and that, subject to the principles outlined in the Data Protection Act (1988) and the provisions of the Care Standards Act (2000), it may be shared with the HCPC and relevant individuals or departments within The Open University.
I confirm that I am happy for you to contact my sponsoring agency regarding any information provided on this form or on my Enhanced Disclosure and Barring Service disclosure.
Full name
Signature Date
(Original or e-signature only)
7 Employer/Sponsor declaration
I confirm that I have seen the declaration form and to the best of my knowledge the candidate is suitable for social work training.
Please provide a supporting statement if the candidate has made any declarations on this form. You may use a separate sheet if necessary.
Full name
Signature Date
(Original or e-signature only)
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