1. Been Cautioned Or Convicted for a Relevant Offence; Or

Criminal Convictions and Cautions Self Declaration Form 2014-2015 (STAFF) The Safeguarding Vulnerable Groups Act (SVGA) 2006 places a duty on employers of people working with children or vulnerable adults to make a referral to the DBS in certain circumstances. This is when an employer has dismissed or removed a person from working with children or vulnerable adults (or would or may have if the person had not left or resigned etc.) because the person has:

1. Been cautioned or convicted for a relevant offence; or 2. Engaged in relevant conduct in relation to children and/or vulnerable adults [i.e. an action or inaction (neglect) that has harmed a child or vulnerable adult or put them at risk of harm];or 3. Satisfied the Harm Test in relation to children and/or vulnerable adults. [i.e. there has been no relevant conduct (i.e. no action or inaction) but a risk of harm to a child or vulnerable adult still exists]. Caution or conviction for a relevant offence If an employee who works with children or vulnerable adults in regulated activity has been cautioned or convicted for a relevant offence the employer must make a referral to the DBS. This should be done as soon as the employer is aware of the caution or conviction. A relevant offence is a serious offence that will, subject to consideration of representations where permitted, automatically bar a person from working with children or vulnerable adults. Further information is available on https://www.gov.uk/government/organisations/disclosure-and- barring-service xxxxxxxxxxxxxxx. Primary School All adults who regularly work with children within the school will have successfully completed a DBS Disclosure before they were employed at the School. At xxxxxxxxx. Primary School we recognise that this certificate is a true record at the date in time of completion. In line with best practice, we therefore ask that staff complete an Annual Self-Declaration Form informing the school if any changes in circumstance have occurred since the date of the DBS certificate. Within our safeguarding role and with regard for the duty placed upon the school by the Safeguarding Vulnerable Groups Act (SVGA) 2006 the information received may lead the school to seek advice from the Shropshire Safeguarding Children’s Board and consider whether a DBS referral is required.

Declaration - Please complete the information below accurately and truthfully and add your signature to each to declare your suitability to continue to be employed to work with children.

Title:………………………………………………………... D.O.B:………………………………… Forenames:……………………………………………………………………………………………… Surname:………………………………………………………………………………………………... Job Title:……………………………………………………………………………………………….. Signature 1. I declare that the situation regarding my character has not changed since completing my original CRB/DBS application”

2. I declare that I have not received a police charge, caution or been convicted of a crime either at home or overseas since completing my original CRB/DBS application.”

3. I agree to disclose to the Headteacher any changes in my circumstances as and when such situations may arise and I understand further action may be taken. I have been informed that I am expected to disclose any convictions, cautions, court orders, reprimands and warnings which may affect my suitability to work with children (whether received before or during my employment at the setting). 4. I confirm that I am not living with anyone with a criminal conviction of any sort. If anyone living in the same house has had any criminal conviction then this MUST be notified immediately, in writing, to the Headteacher as it may lead to disqualification by association Signed:………………………………………………………………………Date:……………………