Документ взят из кэша поисковой машины. Адрес оригинального документа : http://star.arm.ac.uk/jobs/2011/EUNAWE/npm_accessNI_enhanced_disclosure_check_form.pdf Дата изменения: Tue Jul 5 18:51:52 2011 Дата индексирования: Mon Feb 4 01:41:46 2013 Кодировка: Поисковые слова: внешние планеты

GOVERNORS OF ARMAGH OBSERVATORY AND PLANETARIUM Consent to AccessNI Enhanced Disclosure Check Form
Please note that this Form must b e returned with your application. The Form is regarded as part of your application and failure to complete and return it will result in disqualification.

CONFIDENTIAL Information about and consent to AccessNI enhanced disclosure check by applicants for posts involving work with children and vulnerable adults.
You have applied for a p osition that Order 2007. Before app ointing anyon check to b e carried out by AccessNI. children and vulnerable adults are not is governed by Safeguarding Vulnerable Groups (Northern Ireland) e to such a p ost, it is our p olicy to ask for an enhanced disclosure This check is to make sure that individuals who might b e a risk to app ointed.

1. Do you have any prosecutions p ending or have you ever b een convicted at a court or cautioned by the p olice for any offence? Delete as appropriate: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES / NO If `YES', please list b elow details of all p ending prosecutions, convictions, cautions, or bind-over orders. Give as much information as you can, including if p ossible the offence, the approximate date of the court hearing and the court that dealt with the matter. (If necessary, continue on a separate sheet.)

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2. Have you ever b een the subject of an Adult or Child Abuse investigation? Delete as appropriate: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES / NO If `YES', please list full details b elow. If p ossible, please provide the approximate date(s).

NAME: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . POSITION APPLIED FOR: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ANY SURNAME PREVIOUSLY KNOWN BY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PRESENT ADDRESS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ALL PREVIOUS ADDRESSES (Within the last five years): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATE OF BIRTH . . . . . . . . . . . . . . . . . . . . . .

PLACE OF BIRTH . . . . . . . . . . . . . . . . . . . . . .

I understand that an AccessNI Enhanced Disclosure Check (as sp ecified ab ove) must b e carried out b efore an offer of app ointment can b e confirmed. I am aware that sp ent convictions may b e disclosed. I declare that the information I have given is accurate and I consent to the check b eing made.

Signature: . . . . . . . . . . . . . . . . . . . . . . . .

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .