Safeguarding Declaration Form

CONFIDENTIAL DECLARATION

Applicants for posts (voluntary or paid) involving regular and direct contact with children and young people under 18 and/or vulnerable adults are required to complete this confidential declaration, as part of our safeguarding procedures.

This form will be treated as strictly confidential and, except under compulsion of law, will be seen only by those acting on behalf of the Young Lives Foundation in respect of the post for which you have applied. All forms will be kept securely under the terms of the Data Protection Act 1998. If you answer ‘yes’ to any question, please give details.

Please read the accompanying notes below the form before submission.


Definitions

Vulnerable Adult | Vulnerable adult refers to a person over the age of 18 who is or may be suffering from mental ill-health, learning difficulty, physical disability, age or illness and who is or may be unable to protect him/herself from harm or exploitation.

Significant Harm | Significant harm involves serious ill-treatment of any kind including neglect, physical, emotional or sexual abuse, or impairment of physical or mental health development.

Questions 1(a) and 1(b):
Declare all convictions, cautions, warnings or reprimands. Posts where the person is working or coming into contact with children/young people or vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974 so that all spent convictions must be declared.

Any technical motoring offences dealt with by fine do not need to be declared.

Question 1(c):
Declare if you are at present under investigation by the police, social services or an employer.

Question 2(a):
You must declare any finding of fact by a civil court that your actions have significantly harmed a child or young person. Declare any court orders made on this basis.

Question 2(b):
Make any statement you wish regarding any incident you wish to declare.

Question 2(c):
Declare any allegations made against you, however long ago, that you have significantly harmed a child or young person. Any allegation must be declared that has been investigated by the police, social services, employer or voluntary body. Checks will be made with the relevant authorities.

Question 3(a):
You must declare any finding of fact by a civil court that your actions have significantly
harmed a vulnerable adult. Declare any court orders made on this basis.

Question 3(b):
Make any statement you wish regarding any incident you wish to declare.

Question 3(c):
Declare any allegations made against you, however long ago, that you have significantly harmed a vulnerable adult. Any allegation must be declared that has been investigated by the police, social services, employer or voluntary body. Checks will be made with the relevant authorities.

Some of the information requested on the form will be checked with the Criminal Records Bureau and a check with the Disclosure & Barring Service. All Information received will be carefully assessed to decide whether it is relevant to the post applied for and will only be used for the purpose of protecting children and young people and/or vulnerable adults.

Question 5:
The Regulations relate to the The Childcare (Disqualification) Regulations 2009 and the Childcare Act 2006:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414345/disqual_stat-guidance_Feb_15__3_.pdf