HEADTEACHER: Mr M Piper 01642 581716

Staff Disqualification Declaration Form

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In completing this form, I confirm that the information provided is true to the best of my knowledge and that:

I understand my responsibilities to safeguard children.

I understand that I must notify the headteacher immediately of anything that affects my suitability including any cautions, warnings, convictions, orders, or other determinations that would render me disqualified from working with children.

Employee disqualification declaration form

Staff Details

Name
Name
First
Last

Section 1 – Orders or other restrictions

Have any orders or other determinations related to childcare been made in respect of you?
Have any orders or other determinations related to childcare been made in respect of a child in your care?
Have any orders or other determinations been made which prevent you from being registered in relation to childcare, children’s homes or fostering?
Are there any other relevant orders, restrictions or prohibitions in respect of you as set out in the Schedule 1 of the Regulations?
Are you barred from working with children?
Are you prohibited from teaching?

Section 2 – Specified and statutory offences

Have you ever been cautioned, reprimanded, given a warning for, or convicted of any offence against or involving a child?
Have you ever been cautioned, reprimanded, given a warning for, or convicted of any violent or sexual offence against an adult?
Have you ever been cautioned, reprimanded, given a warning for, or convicted of any offence under the Sexual Offences Act?
Have you ever been cautioned, reprimanded, given a warning for, or convicted of any offence under Schedule 2 (Repealed Statutory Offences)?
Have you ever been cautioned, reprimanded, given a warning for, or convicted of any offence under Schedule 3 (Specified Offences)?
In relation to the questions within section 1 and section 2 above, have you ever been cautioned, reprimanded, given a warning for, or convicted of any similar offence in another country?

Section 3 – Provision of information

Privacy Policy

We regard your privacy as important and any personal information you give to us will be used in accordance with the Data Protection Act and the General Data Protection Regulations.

We do not store personal information about individuals who visit this site except where they provide contact information via our contact us page and contact forms available on various pages throughout the website.

Any information you provide will only be used for the reasons specified and it will not be shared with any third party without your consent, unless required by law.

Your contact details are kept securely and are only accessed by authorised members of staff as part of the provision of school services. If you do not wish us to keep this contact information please tell us.

This website uses Google Analytics which provides statistical data about the usage of the site. This information is not used to identify individuals, but is collected to provide us with an understanding of the areas of interest on our site and how our site is being used.

If you are connected to the internet you will have an IP Address. This may take the form of a figure, such as 333.333.22.1. The address will be automatically collected and logged as part of the connection of your computer to our web server and may be used to determine the total number of visits to each part of the site. This data is not collected and used for other purposes.

This website contains links to other websites. The School is not responsible for the privacy practices of other sites or organisations and recommends you consult the privacy information on those sites.

This policy will be reviewed and updated versions will be posted on the website.

If you have any questions about the use of your personal information, the Information Commissioner is the independent regulator for both Data Protection and Freedom of Information.