Issue 01/10 / Shared Services HR Form 22
Version 5
Reviewed March 2013

CRB APPLICATION FORM – ID CERTIFICATION

Position for which Disclosure is being requested
Job Title / Vac Ref(if applicable)
Applicants details
Title / Mr Mrs Miss Ms Other ______
Surname / Forename(s)

Evidence of identity seen by Shropshire Council representative

A photocopy of each identification document must be made and then annotated:

“I certify that I have seen this document original”

They should then be signed and dated by the appropriate Officer and returned with this form to the Contacts Team, Shared Services, Guildhall, Frankwell Quay, Shrewbury, SY3 8HQ

Please complete the appropriate boxes below for at least 3 forms of original evidence, at least one of which should be 1, 2, 3 or 4 listed below (Group 1 documents). Note that at least one of the applicant's documents must show their date of birth and at least one must show their current address. Please also refer to the List of Identification Requirements (SRCT Form 22a) for full details of which documents to check – applicants can bring either one document from Group 1 plus any other two documents from Group 1, 2A or 2B.. If you cannot bring any documents from Group 1, you must bring one document from Group 2A plus any other two documents from Group 2A or 2B one of these documents must verify your current address.

Group 1 Documents

1 / Passport Number / Issue Date
Nationality / Date of Birth
Copy Taken? / Expiry Date
2 / UK Driving Licence Number (including issue no)
Date licence valid from / Date of Birth
Licence type: Photocard only (must be shown with paper counterpart)
Current address details checked as accurate against documentation? Yes
Copy Taken? / Yes
3 / UK Birth Certificate Number
Issue Date / Date of Birth
Copy Taken? / Yes
4 / Biometric Residence Permit Number
Expiry Date / Date of Birth
Copy Taken? / Yes

Group 2A Documents

5 / UK Driving Licence Number (including issue no)
Date licence valid from / Date of Birth
Licence type: old paper style
Current address details checked as accurate against documentation? Yes
Copy Taken? / Yes
6 / Non-UK Driving Licence Number
Date licence valid from / Date of Birth
Licence type: Photocard only (must be shown with paper counterpart)
Current address details checked as accurate against documentation? Yes
Copy Taken? / Yes
7 / UK Birth Certificate Number (issued after time of birth)
Issue Date / Date of Birth
Copy Taken? / Yes
8 / Marriage/Civil Partnership Certificate Number
Issue Date / Country of issue: UK Other ______
Copy Taken? / Yes
9 / Other document from Group 2 – Please refer to list and give details
Document Name / Number
Issue Date / Date of Birth
Country of issue UK Other ______
Confirm name & address details checked against documentation? Yes
Copy Taken? / Yes

Group 2B Documents

8 / Bank, Credit Card or Mortgage Statement
(must be issued within last 3 months, containing name and address of applicant)
Confirm name & address details checked against documentation? Yes
Service Provider
Copy Taken? / Yes / Issue Date
6 / National Insurance Number
P45 or P 60 (must be issued within past 12 months)
Copy Taken? / Yes / Issue Date
7 / Recent Utility Bill (Mobile Phone Bill Not Valid)
(must be issued within last 3 months, containing name and address of applicant)
Confirm name & address details checked against documentation? Yes
Service Provider
Copy Taken? / Yes / Issue Date
9 / Other document from Group 2A & B – Please refer to list and give details
Document Name / Number
Issue Date / Date of Birth
Country of issue UK Other ______
Confirm name & address details checked against documentation? Yes
Copy Taken? / Yes / Issue Date
10 / Other document from Group 2A&B – Please refer to list and give details
Document Name / Number
Issue Date / Date of Birth
Country of issue UK Other ______
Confirm name & address details checked against documentation? Yes
Copy Taken? / Yes / Issue Date
APPOINTING OFFICER
Please ensure that you have copied each identification document, annotated it as requested, and included it with this form
Signed / Name
Post Title / Date

PLEASE RETURN THIS FORM WITH CERTIFIED COPIES OF IDENTIFICATION TO:

Contact Team, Shared Services, Shropshire Council, Guildhall, Frankwell Quay, Shrewsbury, SY3 8HQ

HR USE ONLY
Evidence seen and checked by HR Contact staff (tick boxes):
Group One / Group Two
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11
Signed / Name
Post Title / Date