Self Declaration Form Sep13

Please complete and return this form to the HR Manager
Merchiston Castle School is a boarding school and as such, all employees have direct access to young people.
Thus, all posts within Merchiston Castle School are considered exempt from the Rehabilitation of Offenders ct
!"#$. %n practice, this means that all applicants must disclose all previous and pending convictions, even if
they are considered &spent', or be liable to prosecution.
(ith the exception of offences against children, a previous conviction will not automatically bar an applicant
from employment. (e will ma)e all decisions based on careful consideration of all the information available to us.
%n line with *overnment guidance, the +eadmaster,-ursar will, in each case, consider the following.
whether the conviction is relevant to the employment/
the length of time since the offence occurred/
whether the applicant has a pattern of convictions/
whether the applicant's circumstances have changed since the offence was committed.
%t is important that all applicants and existing staff understand the need to disclose convictions, and are actively
encouraged to do so, so that any convictions can be fully discussed during the recruitment process. %f the
+eadmaster,-ursar feels that further clarification is re0uired, further information may be sought from additional
sources, for example, previous employers, placements etc. (e may also as) the applicant to supply additional
references. 1or further information please refer to the 2rotection of 3ulnerable *roups 2olicy.
Disclosure of Criminal Records
ll applicants will be vetted via the Protection of Vulnerable Groups cheme, prior to commencing employment.
More details regarding the 23* scheme can be found at http.,,www.disclosurescotland.co.u),guidance,index.html.
23* records provide Merchiston Castle School with details of an individual's criminal record and other charges and
cautions, irrespective of the time elapsed since conviction. pplicants should be aware that, should a 23*
record show convictions which were not disclosed by the applicant prior to interview, the School will consider this as
a fundamental breach of trust. %f this situation arises the individual is liable to be summarily dismissed or have any
offer of employment withdrawn, irrespective of the nature of the conviction. !t is an offence to apply for a post
for which you are dis"ualified#
Please complete Parts $%& and return this along with your application form# This information will be treated in
the strictest confidence and will only be seen by senior management and authori4ed staff involved in the selection
process. Should you not be selected for a position the form will be shredded.
P'R( $
re you currently sub5ect to any criminal charges or investigations6
78S 9O :
+ave you ever received or been sub5ect to any of the disposals noted in 2art !6 ;if yes
please complete 2art !<
78S 9O :
P'R( $'
Conviction;s<

(arning;s<

Reprimand;s<
Caution;s<

Charge;s<

dmonishment;s<
2rocurator 1iscal 1ine;s<

=ropped Charge;s<

Other
)hat was the incident*s+ that resulted in the above,

Merchiston Castle School, Colinton, 8dinburgh, 8+!> ?2@ A March B?!!
Leading young people in the pursuit of personal excellence
1
elf Declaration
)hen did it happen,
Have you offended since,
)hat have you learnt from your experience,
P'R( -
re you on the Cist "", &=is0ualified from (or)ing with Children' list or a list governed by
the 2rotection of 3ulnerable *roups ;Scotland< ct B??#6
78S 9O :
re you sub5ect to any sanctions imposed by a regulatory body e.g. SSSC, *TC6 ;%f yes
please detail below<
78S 9O :
+ave you ever been sub5ect to an investigation or en0uiry into abuse or other
inappropriate behaviour, either within or outwith the wor)place6
78S 9O :
+ave you ever been suspended from employment or sub5ect to disciplinary action6
78S 9O :
%f you have answered &yes' to any of the above 0uestions please provide details in the space below.
Part . % M/D!C'0 ('(/M/1(
2
=o you suffer from any disease or disorder of which we should be aware which could
prevent you from carrying out the duties of this post6
78S 9O :
re you receiving any regular or occasional treatment from your doctor, eg tablets or
medicine which could prevent you from carrying out the duties of this post6
78S 9O :
+ave you received any medical treatment within the last three years which could prevent
you from carrying out the duties of this post6
78S 9O :
re you registered disabled6
78S 9O :
(ill you re0uire any aids, or adaptations to allow you to fulfil the duties of the post6
78S 9O :
Registered disabled number, if applicable.
%f you have answered yes to any of the above please provide details in the space below.
P'R( & 2 D/C0'R'(!31
% declare that, except for the above disclosed, % have not been found guilty and sentenced by a
court for a criminal offence, either in the @D or abroad.
% give my consent to Merchiston Castle School to carry out a 2rotection of 3ulnerable *roups
chec) and to re0uest references in order to verify the information % have provided in this
declaration form.
% agree to inform Merchiston Castle School if % am convicted of a criminal offence before or after %
ta)e up any post within the organisation. % understand that failure to do so could lead to
disciplinary action and termination of employment.
% can confirm that % have a legal right to wor) in the @D.
% declare that % have not withheld any information.
% consent to medical information relevant to the post for which % am applying being sought from
the doctor who has attended me recently and % authori4e that such information may be given.
Signed.EEEOriol CobachoEEEEEEEEEEEEE =ate.EEEEEB>,?B,B?!$EEEE
9ame. EEEEEEOriol Cobacho ClosaEEEEEEEEEEEEEE
3

Self Declaration Form Sep13

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Please complete and return this form to the HR Manager

2rocurator 1iscal 1ine;s<

)hat was the incident*s+ that resulted in the above,

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