Disclosure of criminal convictions form

All applicants must complete this form in full as part of the application process. Please refer to the guidance notes before completing the following sections. 

Note that the post you have applied for is exempted under the Rehabilitation of Offenders Act (Exceptions Order) 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed.
*If any circumstances change which would affect your response to this question, you must inform the Human Resources department of the details without unnecessary delay.
I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION GIVEN ON THIS FORM IS CORRECT AND COMPLETE. I understand that any false information could result in my application being rejected or, if appointed, in my dismissal from employment. I understand that any offer of employment made to me by Coram will be subject to a check with the Disclosure and Barring Service (DBS) and I hereby give my consent to Coram carrying out the relevant DBS status check in line with the DBS Code of Practice. I declare that I am not currently on the DBS Barred List and that I will notify the Human Resources department immediately if I do become barred in future.

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