Safeguarding Pupils at Middlestown Primary Academy – to be submitted with Application form

Middlestown Primary Academy is obliged by law to operate a checking procedure for employees who have substantial access to children and young people.

I confirm that I am not barred by the DBS from working with or applying to work with, or included on the DBS Children’s Barred List.

I confirm that I am not subject to a prohibition order and / or interim prohibition order by the National College for Teaching and Learning.

I confirm that no child/ren in my care, or in any household in which I have lived as an adult, has been placed upon a child protection register/subject to a child protection plan or placed in care.

I confirm that I have never been disciplined because of inappropriate behaviour towards a child which may have harmed them or put them at risk of harm.

Rehabilitation of Offenders Act (ROA) 1974 (Exceptions) Order 1975 (as amended 2013)

The post for which you are applying is exempt from the provision of Section 4(2) of the above Act which means you must not withhold information about convictions, cautions, reprimands or final warnings which for other purposes are spent under the provisions of the Act. The amendment made in 2013 means however, that you do not have to disclose particular cautions or convictions due to certain categories of offence being “filtered”.

It is your responsibility to read the guidance on the Disclosure and Barring Service website or the Academy’s guidance located in the vacancies section in order to ensure you declare a caution or conviction if required as set out by the amendment. Please seek advice if you are unsure.

Name In Full:

Post Applying For:

Details of any convictions, cautions, reprimands or final warnings that are exempt from being filtered in line with DBS guidance:

If successfully employed, at the start of every Academic year, you will also be asked to complete a staff declaration form that will ask you to re-confirm your conviction status.I agree that the appropriate enquiry may be made to the DBS and confirm that the above information is correct to the best of my knowledge. I understand that withholding, falsifying or omitting relevant information may disqualify me from employment or result in disciplinary action if information comes to light following appointment.

Signed:Date:

Middlestown Primary Academy is strongly committed to safeguarding and promoting the welfare of children.

All posts are subject to satisfactory vetting, including a satisfactory enhanced disclosure from the DBS.