Criminal Record Self-Disclosure Form B Criminal record self-disclosure form B Your details Your Name * Role you’re applying for * Relevant Convictions Do you have any convictions or cautions that would not currently be filtered by the DBS? * Yes No The term ‘convictions’ is used to refer to any sentence or disposal issued by a court. The term ‘cautions’ includes reprimands and final warnings. You do not need to disclose anything that would be currently filtered from the Police National Computer by the Disclosure & Barring Service. If you’re not sure if your convictions or cautions are filtered, you can find out more from https://hub.unlock.org.uk/knowledgebase/what-will-be-filtered-by-dbs/ If you have answered Yes, there are three ways to provide us with the details: Provide the offence dates, dates of conviction/caution, offence types and sentences in the space below. Provide the offence dates, dates of conviction/caution, offence types and sentences received on a separate document and attach this below. Provide the offence dates, dates of conviction/caution, offence types and sentences received on a separate document and send it back to us in an envelope along with confirmation of your name and the role you're applying for. If you are providing details in the post please indicate by ticking the box below. Full Details If you have the details in a separate document, please upload here. Drop a file here or click to upload Choose File Maximum file size: 516MB I am sending the details separately Yes Criminal records data and your rights Citizens Advice - Hart collects your criminal convictions information to assess your suitability for a role. As stated in the criminal records and convictions policy for applicants we may also need to share the information on this form and attached document (if you have included further detail), with ADS Insurance Broker (and subsequently the insurer) if additional cover is required. We process this data on the basis of substantial public interest in order to safeguard our clients against harm. You have legal rights over your data, including access to it, and the right to ask that it is corrected, restricted or deleted. If you have any questions about the use of your data, please contact Citizens Advice – Hart, Chief Officer Sam Mabbott (ceo@citizensadvicehart.org.uk) If you are recruited for a role, we will keep the self-disclosure form for 6 months from the date of receipt. We will keep the risk assessment, and a record of the decision for 6 years following the end of volunteering. If you are not recruited, we will keep the self-disclosure form for 6 months from the date of this decision. We will keep the risk assessment and record of the decision for 1 year. If you are human, leave this field blank. Declaration and Submission
