Recruitment Check Form

Please answer all questions and save/send with your covering letter and CV. By doing so you are making the declaration shown at the end of this form.

Your Name:......

PART 1
Do you have a right to live and work in the UK?*
If eligible and you are a non-EEA national, please indicateyour immigration status and any expiry date of any visa
You will be asked to provide original identity documents as proof during the recruitment process
Have you made a previous application to UCEM?
If yes, what role and when?
Are there any dates in the next 4 weeks that you may not be available for interview?
Should you be selected for an interview, would you require any special arrangements to be made to enable you to attend an interview? This may include any special arrangements on account of a disability
If yes, please detail your requirements here
For any disability please give brief details of the effects of your disability on your day-to-day activities and any other information that you feel would help us to accommodate your needs
If relevant for the job i.e. on the Person Specification, do you hold a full driving licence?
If yes, do you have any current endorsements? / Not applicable to this role
What is your actual current salary per annum? / Not applicable to this role
Should you be offered the job, what would your notice period be? / Not applicable to this role
PART 2: Rehabilitation of Offenders Act 1974
The post for which you are applying is exempt from certain provisions of the Rehabilitation of Offenders Act 1974. You are therefore required to disclose all and any past or pending cautions or convictions, whether spent or otherwise, unless it is either a “protected caution” or a “protected conviction” under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. All information provided will be kept in the strictest confidence and only used for the purpose of assessing your suitability for the post you have applied for.
Please specify below details of all and any past or pending cautions or convictions, whether spent or otherwise, except for protected cautions or convictions. If you have no past or pending cautions or convictions, please specify “None”.
Details here: / Or state None here:
Guidance
To answer the question “Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)”:

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website:

Please note any appointment to a UCEM job role is conditional upon and subject to either a standard or enhanced certificate (criminal record check) issued by the Disclosure and Barring Service (DBS). In the case of a job role which requires an enhanced certificate, this will also include a check of the DBS Barred Lists. The job advert and job specification document will specify the level of check applicable to the job role.

Declaration

I declare that the information I have given on this form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified or, if I have already been appointed, my contract may be terminated.

By submitting this form with my job application to UCEMI consent to undergo a DBS checkshould my job application be successful and I receive an offer of employment.

I also hereby give my consent to UCEM processing my data supplied on this form for the purpose of recruitment and selection activities. I accept that if my job application is successful, this form will be part of my HR file and, in that case, I consent to the data on it being processed for all purposes in connection with my ongoing employment.

Form last updated by HR: January 2018

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