CRIMINAL CONVICTIONS SELF DECLARATION FORM

PRIVATE & CONFIDENTIAL

This post is exempt from the Rehabilitation of Offenders Act 1974 by the (Exclusions & Exceptions) (Scotland) Order 2003. As such you are required to declare all criminal convictions (including ‘spent’ convictions) and any pending court cases. If you have no pending court cases or criminal convictions you must clearly write NOT APPLICABLE in the box below and sign the declaration.

The criminal record information which we require to best place each individual is confidential and will be treated as such under the terms of the Rehabilitation of Offenders Act 1974 and the Data Protection Act 1998.

This organisation strives to recruit the best person for the job. On some occasions this is an ex-offender. Interviewers are trained so that all candidates will be assessed on their merit and only convictions relevant to the post will be taken into account. You should be prepared to answer further questions at interview if required.

Please provide the following details of all convictions (including cautions, deferred sentences, absolute discharges, bound over, probation orders and investigations) and any pending court cases:-

  1. The type of offence, the date of the conviction, the sentence passed and which court passed sentence?
  2. What were your circumstances at the time?
  3. What have you learned from the experience?
  4. What is your present situation and future expectations?
  5. Any other relevant information

Please continue on a separate sheet if you need to
 I have not withheld any information which may affect my application
 Any false, misleading or omission of information may lead to dismissal

Name Signature Date

Please seal this form in a separate envelope marked confidential and return with your completed application form. We guarantee that this information will only be seen by those who need to see it as part of the recruitment process. Information about an applicant’s criminal record will only be looked at for those who have been short-listed and invited for interview. Information about applicants who have not been invited for interview will be destroyed unseen.