Appendix 3 to Annex a To

APPENDIX 3 TO ANNEX A TO

SO BFG 2115

BFG Form 28 (B)

(Revised Jul 11)

APPLICATION FOR CATEGORY 3 SECURITY CLEARANCE AND RELIABILITY CHECK

Check(s) required:
(To be completed by Recruiting Authority Staff) / Cat 3 Dependant / Cat 3 Enhanced / Reliability Check

For an Initial Reliability Check on recruitment complete Parts 1 & 3 only.

For a Category 3 or Category 3 Enhanced Security Clearance complete Parts 1, 2, & 3.

Part 4 (continuation sheet) is to be used for additional information/details.

Part 5 is to be completed by Recruitment Agency/Sponsor staff ONLY.

This form is to be filled in block letters using a black pen or typescript.

Answer all questions. Where the answer is not known or not applicable, enter N/K or N/A.

IMPORTANT - PLEASE READ THESE NOTES BEFORE COMPLETING THIS FORM

SECURITY VETTING In the interests of UK national security, safeguarding Parliamentary democracy and maintaining the proper security of the Government's activities, it is the policy of HMG that no one should be employed in connection with work the nature of which is vital to the interests of the State;

(a) who is, or has previously been involved in, or associated with, espionage, terrorism, sabotage, or actions intended to overthrow or undermine Parliamentary democracy by political, industrial or violent means; (this includes membership of, or association with, any group which is involved with such activities).

(b) who is susceptible to pressure or improper influence, for example because of current or past conduct; has shown dishonesty or lack of integrity which throw doubt on their reliability, or has demonstrated behaviour, or is subject to circumstances which may otherwise indicate unreliability.

In accordance with this policy all individuals in posts which require them to have access to MoD protectively marked information or assets may be subject to a check against the National Collection of Criminal Records.

RELIABILITY CHECK Checks for British Nationals, including Dependants with periods of residency outside of the UK in the past 5 years or more who intend to work with children are to be made to the Vetting Section, HQ 1 MI BN,BFPO 140. This procedure is to be followed as the Criminal Records Bureau (CRB) is unable to check against BFPO or local German civilian addresses. A Reliability Check will be initiated by the Employment Disclosure Office in liaison with the German Police, Security Authorities and other relevant Vetting Authorities with results notified to the Sponsor.

Applicants with residential civilian addresses in both the UK and Overseas in the past 5 years are required to complete both the CRB disclosure application and BFG Form 28(B).

The CRB is only able to access information within the UK as part of its Disclosure Service. There is a requirement therefore to check against lists held by certain overseas countries working with children and vulnerable persons.

CRIMINAL DECLARATIONWhen completing this form, you must declare any criminal convictions that you may have, including those which are "Spent". In accordance with the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders (Northern Ireland) Order 1978 (Exceptions) Order 1979, spent convictions may also be taken into account where the protection of public safety or public order is involved. The relevance of a particular criminal offence is a matter for the Department to decide.

Certain positions where employees have both direct and indirect access to children, young people and vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974 and all subsequent amendments (England and Wales) and the Rehabilitation of Offenders Act 1978 all subsequent amendments (Northern Ireland). For those positions you are not entitled to withhold information about convictions that would otherwise by considered ‘spent’.

You must therefore declare all convictions, including those which involved a Juvenile Court, whether or not “Spent” under the above acts.

PART 1

A.APPLICANTS/EMPLOYEE DETAILS

Current Surname:
Any other Surname(s) Used:
Full Forename(s):
Title, (i.e. Mr, Mrs, Dr, Major):
Date of Birth:
Current Marital Status:
Place of Birth (Please enter town/city names, county/district and country in full as recorded on your Birth Certificate):
Town:
County:
Country:

B.NATIONALITY AND IMMIGRATION SATUS

Nationality and Immigration Status (If change of Nationality please include dates):
Nationality at Birth:
Current Nationality (if different, to include any dual Nationality):
Have you ever possessed any other nationality or citizenship?
YES NO
If YES, please specify:
Are you subject to immigration control?
YES NO
If YES, please specify:
Passport and ID Card Number: / Passport Number ID Card Number

C.MILITARY SERVICE

Please provide details of any military service:
Number and Rank (on discharge):
Date of Commencement:
Branch of the Forces or Organisation:
Reason for Discharge:
Date of Discharge:

C.MILITARY SERVICE (Continued)

If you are still serving give details below of current unit and address:
Unit:
Address:
BFPO :

D.CURRENT AND PREVIOUS CIVILIAN ADDRESSES

Please supply your currentResidential Civilian and any other Residential Civilian Addresses covering the last 5 years in date order (starting with current and working backwards):
Current Address:
Town/City: / County:
Postcode/PLZ: / Country:
From:
Previous addresses:
From (Month/Year): / To (Month/Year):
Address:
Town/City: / County:
Postcode/PLZ: / Country:
From (Month/Year): / To: (Month/Year):
Address:
Town/City: / County:
Postcode/PLZ: / Country:
From (Month/Year): / To: (Month/Year):
Address:
Town/City: / County:
Postcode/PLZ: / Country:
From (Month/Year): / To (Month/Year):
Address
Town/City: / County:
Postcode/PLZ: / Country:

PART 2 IMPORTANT: only to be completed for Category 3 (Dependant) and Category 3 (Enhanced) Security Clearance Applications.

A.HEAD OF FAMILY MILITARY/UKBC DETAILS

Full Name:
Rank/Grade:
Service/Staff No:
Unit/Branch:

1. SPOUSE/PARTNER`S DETAILS

Current Surname:
Any other Surname Used:
Full Forename(s):
Date of Birth:
Place of Birth (Please enter town/city names, county/district and country in full as recorded on your Birth Certificate):
Town:
County:
Country
Nationality (If change of Nationality please include dates):
Current Nationality :
Previous Nationality:
Please supply Spouse/PartnerscurrentResidential CivilianAddress:
From (Month/Year):
Current Address:
Town/City: / County:
Postcode/PLZ: / Country:

C.EMPLOYMENT/ACADEMIC HISTORY

Please give details of your last 5 years Employment and/or Academic History starting with most recent:
Company/Firm/Education provider and full address: / Date From: (Month/Year): / Date To: (Month/Year): / Job Title (Brief description):

PART 3

CRIMINAL RECORD DECLARATION

Have you ever been convicted or found guilty by a court (including juvenile court) of ANY offence in ANY country, put on Probation, received a formal caution or absolute/conditional discharge or bound over after being charged with any offence or is there any action pending against you?
YES NO
If you have answered YES please give details of the offence(s) referred to:
Nature of offence(s):
Sentence(s) Awarded: / Date(s):
Have you ever been convicted by a Court-Martial or sentenced to Detention or Dismissal or fined whilst serving in the Armed Forces of the UK or any other Commonwealth or Foreign country?
YES NO
If you have answered YES please give the following details:
Nature of offence(s):
Sentence(s) Awarded: / Date(s):
Do you know of any other matters in your background which might cause your reliability to be called into question?
YES NO
If you have answered YES please give the following details:
Notes:
If you are appointed to certain positions, a check against the National Collection of Criminal Records will be undertaken and documentary evidence sought to confirm your answers.
Important: Data Protection Act (1998). This form asks you to supply “personal” data as defined by the Data Protection Act 1998. You will be supplying this data to the appropriate HR, Security Authority and or Employment Disclosure Office where it may be processed exclusively for the purpose of a check against the National Collection of Criminal Records. The HR, Security Authority and or Employment Disclosure Office will protect the information which you provide and will ensure that it is not passed to anyone who is not authorised to see it.
If you have any concerns, about any of the questions or what we will do with the information you provide, please contact the person who issued this form for further information.

DECLARATION

I understand that the vetting process may involve a criminal record check, which will, if undertaken, be conducted on grounds of national security and employment disclosure suitability for posts working with Vulnerable Groups. I understand this will result in any "spent" convictions held against me being disclosed on a strictly in confidence basis to the MOD Security Vetting and or Employment Disclosure organisations for assessment.
By signing the declaration on this form, I am explicitly consenting for the data I am providing to be processed in the manner described above.
I undertake to notify any material changes in the information I have given above, including any future criminal convictions, to the HR, Security Authority and or Employment Disclosure Office concerned.
Date: / Signature:

PART 4

CONTINUATION SHEET

Please use this section to give any additional information/details to any question/s asked on this form.

Part/paragraph / Additional information/details

PART 5

FOR RECRUITMENT AGENCY/SPONSOR STAFF USE ONLY

Certificate of Identity all documents must be current. Expired documents will not be accepted.
Document type / Date of Issue / Date of expiry

Certificate of identity: A certified true copy of the applicant’s identity documents must be attached to the application when forwarding to the Security Vetting Section.

In accordance with JSP 440, SOBFG 2115 and SOBFG 3352 I certify that the questionnaire has been checked for completeness and accuracy and I have satisfactorily established the identity of the above named applicant and obtained references.

Type of Employment:
Location:
Unit:
Future Start Date:

CHECKED BY

Name: / Unit:
Post: / Tel No:
Signature: / Date
UNIT STAMP

NOTE:

The Recruiting Authority is to retain the original form as part of the Baseline Personnel Security Standard.

For a Reliability Check 1 copy is to be sent and for a Reliability Check and Category 3/3 Enhanced Clearance 2 copies are to be sent to:

Vetting Section, HQ 1MI BN, BFPO 140.