Title |
Reference/Issue Date |
Checks on Doctors’ and Dentists’ Registration, Identity and References |
NHS Circular 1977 (PCS)23 |
Appointment Procedures for Hospital and Community Medical and Dental Staff |
NHS Circular: PCS (DD) 2001/1 |
Code Of Practice in the Appointment and Employment of Locum Doctors |
NHS Circular: PCS (DD) 1998/1 |
Equal Opportunities Policies (PIN Guideline) |
2001 |
Secondment (PIN Guideline) |
May 2003 |
Fixed Term Contracts (PIN Guideline) |
March 2005 |
Supporting Work-Life Balance (PIN Guideline) |
October 2005 |
Recruitment and Retention of Internationally Qualified Nurses in NHSScotland |
NHS HDL (2006)53 |
Code Of Practice for the International Recruitment of Healthcare Professionals in Scotland |
2006 |
Changes to the Immigration Provisions for Post Graduate Doctors and Dentists |
NHS HDL (2006)20 |
1 Issued within the past 12 months
2 Documentation should be less than 3
months old
Guidance on checking documentation
Checking the documentation for authenticity
Always:
Passport (UK or overseas)
Photo driving licence
Birth certificate
The Disclosure Scotland and the Criminal Records Bureau (CRB) cannot currently access overseas criminal records or other relevant information as part of its Disclosure service. If you are to recruit people from overseas and wish to check their overseas criminal record, a CRB Check may not provide a complete picture of their criminal record that may or may not exist. To help you get a fuller picture of their background, the CRB provides guidance on how you can get further information from the countries listed below.
Click on the links below to access information on the CRB website relating to overseas criminal records. Alternatively refer to the link at para 5.3 of this document.
If the country that you are looking for is not listed you may wish to contact the country’s representative in the United Kingdom. For further guidance on countries that have a UK representative please refer to para 5.4 of this document.
When checking if an applicant has the legal right to work in the UK, you should ideally use one document from the list below.
If the applicant is unable to produce one of the above documents, they can produce either of the two combinations below. However, you cannot mix the two combinations together.
First combination
Along with checking and copying a document giving the person’s National Insurance Number, you must also check and copy only one of the following documents:
Second combination
None of the document descriptions reflect the precise wording contained in the legislation. If you would like to obtain a full account of the legal changes, this will be available in the booklet the Home Office will be producing alongside this guidance. Further guidance on preventing illegal working can be found at www.workingintheuk.gov.uk .
General Medical Council (GMC)
There are three ways to check a doctor’s registration status prior to employment:
On 31 March 2006, the GMC introduced a register of doctors who are eligible to work in general practice in the UK.
The GP register is a register of general practitioners. It can be accessed via http://www.gmc-uk.org .
Information relating to a doctor’s registered address, date of birth, photograph and whether or not a doctor is subject to investigation under fitness to practise procedures will no longer be available to enquirers, but a restricted group, such as employers.
Please visit www.gmc-uk.org for further information.
General Chiropractic Council (GCC)
A chiropractor’s registration can be confirmed via:
The GCC has published its disclosure policy: Regulatory Committees and Appeal Tribunals, which can be found on their website. In the interest of patient safety, the GCC takes a transparent approach to providing information on proceedings and findings in relation to fitness to practise.
The website also provides:
General Dental Council (GDC)
A dentist’s or dental care professional’s registration can be checked online at www.gdc-uk.org .
In all cases, the GDC can provide a faster more efficient service if the request contains the necessary information and the dentist’s/dental care professional’s consent. Some of the information required is not publicly available in the Dentist’s Register and the Dental Care Professionals Register. In particular, the GDC will need to see a copy of the dentist’s/dental care professional’s consent before they can disclose any information that is not publicly available.
Application Process
The GDC can process applications more quickly if the consent includes at least the following, or words to the same effect:
‘I consent to a request being made by NHS…. to … [the GDC or any … regulatory … body in the United Kingdom or elsewhere,] for information relating to a current investigation or an investigation where the outcome was adverse, by them into my professional conduct and to the disclosure of such information to the Health Board by [the body in question OR the GDC].’
The consent form must also include:
General Optical Council (GOC)
Employers can check a registrant’s status on the General Optical Council’s online register at www.optical.org by entering the GOC number and individual’s surname. The GOC publishes details of recent and future fitness to practise hearings.
Employers can also:
General Osteopathic Council (GOSC)
An osteopath’s registration status can be verified on the GOSC’s website at www.osteopathy.org.uk . For further information concerning Fitness to Practise proceedings, employers can ring the Council directly on 0207 357 6655. They can also write to the GOSC at: General Osteopathic Council, 176 Tower Bridge Road, London SE1 3LU.
Scottish Social Services Council (SSCC)
A Social Worker’s registration can be checked on the SSCC website at www.sssc.uk.com . Scottish Social Services Council, Compass House, 11 Riverside Drive, Dundee DD1 4NY. Tel: 0845 60 30 891.
Health Professions Council (HPC)
The following health professionals are regulated by the HPC: arts therapists, biomedical scientists, chiropodists, podiatrists, clinical scientists, dieticians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, prosthetists, orthotists, radiographers and speech and language therapists.
A health professional’s registration status can be checked on the HPC’s website at www.hpc-uk.org . If a health professional’s registration status has changed this is immediately entered onto the register.
Fitness to Practise cases are listed on HPC’s website and after a hearing, the decision is posted online.
Employers are strongly encouraged to use the HPC’s online register, but if this is not possible, registration can also be checked via:
Alternatively, they can write to the HPC at the Health
Professions Council,
Park House, 184 Kennington Park Road, London SE11 4BU.
If employers wish to make an allegation that a health professional’s fitness to practise is impaired, they can contact the HPC Fitness to Practise team. Allegations or complaints should be put in writing. For further information on fitness to practise contact the Fitness to Practise team on:
Nursing & Midwifery Council (NMC)
The NMC offers three ways to confirm registration status:
The service will inform an employer if a practitioner has the following status:
It will not show if someone is under investigation. For further information on the status of a practitioner an employer would need to write to the NMC’s Fitness to Practise Department.
The NMC website also contains an NMC Circulars page which includes details of practitioners who have been struck off, suspended or cautioned during the previous month. The NMC keeps this information online for three months. Previous circulars can be obtained on request.
Royal Pharmaceutical Society of Great Britain (RPSGB)
The RPSGB website www.rpsgb.org.uk allows employers to check a pharmacist’s registration. The register provides details of pharmacists who hold full-time, part-time, retired or overseas registration. Registration can be confirmed by:
A pharmacist’s eligibility to practise in Great Britain depends on their type of registration, which is shown in their entry on the register. Pharmacists who have paid the 2005 retention fee will have either P or NP in their entry:
Pharmacists who have not yet paid the 2005 retention fee will have either f, p, r, I or o in their entry. Only pharmacists holding full-time (f) or part-time (p) registration are eligible to practise; pharmacists holding retired (r), ill health (i) or overseas (o) registration are not eligible to practise.
Details of current and recent fitness to practise inquiries can also be obtained from the website.
Regulatory body |
Website address |
Telephone
|
Address |
Ways to check registration |
General Medical Council |
0845 357 8001 9.00am-17.00pm |
Regent’s Place, |
|
|
General Chiropractic Council |
0207 713 5155 |
44 Wicklow Street, |
|
|
General Dental Council |
0207 887 3800 |
37 Wimpole Street, |
|
|
General Optical Council |
0207 580 3898 |
41 Harley Street, |
|
|
General Osteopathic Council |
0207 357 6655 |
176 Tower Bridge Road, London |
|
|
Scottish Social Care Council |
0845 60 30 891 |
Compass House, |
|
|
Health Professions Council |
0845 3004 472 |
Park House, |
|
|
Nursing and Midwifery Council |
020 7333 9333 |
23 Portland Place, |
|
|
Royal Pharmaceutical Society Great Britain |
020 7735 9141 |
1 Lambeth High Street, London |
|
Employer Notes
This Model Declaration is intended for use only in connection with positions that are exempted from the Rehabilitation of Offenders Act 1974 and for which an Enhanced Disclosure may be sought under the provisions of Section 115 of the Police Act 1997. Use of this model declaration form is mandatory.
The use of this Model Declaration should be seen as complementing existing good recruitment practice, and as one part of the overall selection process. The Model Declaration is not a substitute for the full range of pre-appointment checks that are required by law or that are available to health bodies. It should be remembered that appointing persons on the basis of information that applicants have themselves provided can never be risk free.
NHS Employers has published guidance concerning the Criminal Records Bureau on the NHS Employers website at www.nhsemployers.org.
Boards are expected to comply with the Data Protection Act 1998 when processing applications. For the purpose of this Model, it is presumed that Boards provide applicants with separate information [referred to for the purpose of this Model Declaration as ‘Guidance Notes for Applicants’] that reflects local procedures, to ensure that they deliver compliance.
Confidential
Before you can be considered for appointment in a position of trust with [organisation] we need to be satisfied about your character and suitability.
Please read the following notes carefully before completing this Declaration Form. If you require further information, please contact [insert details]. All enquiries will be treated in confidence.
[organisation] aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation, age. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other information declared.
Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe has a bearing on your suitability for the position. If we do not raise this information with you, this is because we do not believe that it should be taken into account. In that event, you remain free to discuss any of that information or any other matter that you wish to raise. As part of assessing your application, we will only take into account relevant criminal record and other information declared.
The Data Protection Act 1998 requires us to advise you that we will be processing your personal data and, generally, to obtain your consent before processing personal data about you. Processing includes: holding, obtaining, recording, using, sharing and deleting information. The Data Protection Act 1998 defines ‘sensitive personal data’ as racial or ethnic origin, political opinions, religious or other beliefs, trade union membership, physical or mental health, sexual life, commission or alleged commission of offences and any proceedings for any offence committed or alleged to have been committed.
The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 1998, and may also be used for the purpose of determining your application for this position and may also be used for the purpose of enquires in relation to the prevention and detection of fraud. Once a decision has been made concerning your appointment, for successful applicants the declaration will be retained on their personal file, if unsuccessful, the declaration will be destroyed after 6 months. This declaration will be kept securely and in confidence, and access to it will be restricted to designated persons within the Health Board who are authorised to view it as a necessary part of their work.
Please ensure that you read the ‘Guidance Notes for Applicants’ that accompanied your application form carefully before completing this Declaration Form. They provide you with further and more detailed information about how your application will be processed, the persons to whom it will be disclosed and the checks that will be done to verify the information provided.
Please answer all of the following questions. If you answer ‘Yes’ to any of the questions, please provide full details in the space indicated. Please also use the space below to provide any other information that may have a bearing on your suitability for the position for which you are applying. You may continue on a separate sheet if necessary, and you may attach supplementary comments should you wish to do so.
The position for which you have applied is exempted from the Rehabilitation of Offenders Act 1974. This means that you must declare all criminal convictions, including those that would otherwise be considered ‘spent’.
Answering ‘Yes’ to any of the questions below will not necessarily bar you from appointment. This will depend on the nature of the position for which you are applying and the particular circumstances.
1. Are you currently bound over or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or in any other country?
Note: You do not need to tell us about parking offences.
NO
YES
If YES, please include details of the order binding you over and/or the nature of the offence, the penalty, sentence or order of the Court, and the date and place of the Court hearing. |
2. Have you ever received a police caution, reprimand or final warning?
NO
YES
If YES, please include details of the caution, reprimand or final warning, including the date and reason administered. |
3. Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?
Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you. You do not need to tell us if you are charged with a parking offence.
NO
YES
If YES, please include details of the nature of the offence with which you are charged, date on which you were charged, and details of any on-going proceedings by a prosecuting body. |
4. Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you?
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the police. |
5. Are you aware of any current NHSScotland Counter Fraud Services investigation following allegations made against you?
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the NHSScotland Counter Fraud Services. |
6. Have you ever been investigated by the police, NHSScotland Counter Fraud Services or any other investigatory body resulting in a caution, conviction or dismissal from your employment? (Investigatory bodies include Local Authorities, Customs and Excise, Immigration, Passport Agency, Inland Revenue, Department of Trade and Industry, Department of Work and Pensions, Security Agencies, Financial Service Authority, Banks and Building Societies, General, Life Insurance Companies – this list is not exhaustive, and you must declare any Investigation conducted by an Investigatory Body).
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the Investigatory Body. |
7. Have you ever been dismissed by reason of misconduct from any employment, office or other position previously held by you?
NO
YES
If YES, please include details of the employment, office or position held, the date that you were dismissed and the nature of allegations of misconduct made against you. |
8. Have you ever been disqualified from the practice of a profession, or required to practise subject to specified limitations following fitness to practise proceedings, by a regulatory or licensing body in the United Kingdom or in any other country?
NO
YES
If YES, please include details of the nature of the disqualification, limitation or restriction, the date, and the name and address of the licensing or regulatory body concerned. |
9. Are you currently the subject of any investigation or fitness to practise proceedings by any licensing or regulatory body in the United Kingdom or in any other country?
NO
YES
If YES, please include details of the reason given for the investigation and/or proceedings undertaken, the date, details of any limitation or restriction to which you are currently subject, and the name and address of the licensing or regulatory body concerned. |
10. Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for the position for which you are applying*
NO
YES
If YES, please include details of the nature of the prohibition, restriction, or limitation, when and by whom it was made. |
* include this question where the position involves regular contact with children in the normal course of the postholder’s duties or is a ‘regulated position’ under the provisions of the Protection of Children Act 1999 (as amended).
If you have answered ‘yes’ to any of the questions above, please use this space to
provide details. Please indicate clearly the number(s) of
the question that you are answering: |
Declaration
I have read the ‘Guidance Notes for Applicants’ that accompanied my application form, and I consent to the information provided in this Declaration Form being used by [organisation] for the purpose of assessing my application, and for enquiries in relation to the prevention and detection of fraud.
I confirm that the information that I have provided in this Declaration Form is correct and complete. I understand and accept that if I knowingly withhold information, or provide false or misleading information, this may result in my application being rejected, or if I am appointed, in my dismissal, and I may be liable to prosecution.
Please sign and date this form.
SIGNATURE _____________________________________
NAME (in block capitals) ____________________________
DATE _______________________
Note: if you wish to withdraw your consent at any time after completing this Declaration Form, please contact [insert details]
Employer Notes
This Model Declaration is intended for use only in connection with positions that are exempted from the Rehabilitation of Offenders Act 1974 and which require a Standard Disclosure. Use of this model declaration form is mandatory.
The use of this Model Declaration should be seen as complementing existing good recruitment practice, and as one part of the overall selection process. The Model Declaration is not a substitute for the full range of pre-appointment checks that are required by law or that are available to health bodies. It should be remembered that appointing persons on the basis of information that applicants have themselves provided can never be risk free.
The NHS Employers Organisation has published guidance concerning the Criminal Records Bureau on the NHS Employers website at www.nhsemployers.org.
Boards are expected to comply with the Data Protection Act 1998 when processing applications. For the purpose of this Model, it is presumed that Boards provide applicants with separate information [referred to for the purpose of this Model Declaration as ‘Guidance Notes for Applicants’] that reflects local procedures to ensure that they deliver compliance.
Confidential
Before you can be considered for appointment in a position of trust with [organisation] we need to be satisfied about your character and suitability.
Please read the following notes carefully before completing this Declaration Form. If you require further information, please contact [insert details]. All enquiries will be treated in confidence.
[organisation] aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, gender, martial status, religion, disability, sexual orientation, age. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other information declared.
Prior to making a final decision concerning your application we shall discuss with you any information declared by you that we believe has a bearing on your suitability for the position. If we do not raise this information with you, this is because we do not believe that it should be taken into account. In that event, you remain free to discuss any of that information or any other matter that you wish to raise. As part of assessing your application, we will only take into account relevant criminal record and other information declared.
The Data Protection Act 1998 requires us to advise you that we will be processing your personal data and, generally, to obtain your consent before processing personal data about you. Processing includes: holding, obtaining, recording, using, sharing and deleting information. The Data Protection Act 1998 defines ‘sensitive personal data’ as racial or ethnic origin, political opinions, religious or other beliefs, trade union membership, physical or mental health, sexual life, commission or alleged commission of offences and any proceedings for any offence committed or alleged to have been committed.
The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 1998, and may also be used for the purpose of determining your application for this position and may also be used for the purpose of enquires in relation to the prevention and detection of fraud. Once a decision has been made concerning your appointment, for successful applicants the declaration will be retained on their personal file, if unsuccessful, the declaration will be destroyed after 6 months. This declaration will be kept securely and in confidence, and access to it will be restricted to designated persons within the Health Board who are authorised to view it as a necessary part of their work.
Please ensure that you read the ‘Guidance Notes for Applicants’ that accompanied your application form carefully before completing this Declaration Form. They provide you with further and more detailed information concerning how your application will be processed, they also include details of purposes for which information about you will be processed, the persons to whom it will be disclosed and the checks that will be done to verify the information provided.
Please answer all of the following questions. If you answer ‘Yes’ to any of the questions, please provide full details in the space indicated. Please also use the space below to provide any other information that may have a bearing on your suitability for the position for which you are applying. You may continue on a separate sheet if necessary, and you may attach supplementary comments should you wish to do so.
The position for which you have applied is exempted from the Rehabilitation of Offenders Act 1974. This means that you must declare all criminal convictions, including those that would otherwise be considered ‘spent’.
Answering ‘Yes’ to any of the questions below will not necessarily bar you from appointment. This will depend on the nature of the position for which you are applying and the particular circumstances.
1. Are you currently bound over or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or in any other country?
Note: You do not need to tell us about parking offences.
NO
YES
If YES, please include details of the order binding you over and/or the nature of the offence, the penalty, sentence or order of the Court, and the date and place of the Court hearing. |
2. Have you ever received a police caution, reprimand or final warning?
NO
YES
If YES, please include details of the caution, reprimand or final warning, including the date and reason administered. |
3. Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?
Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you. You do not need to tell us if you are charged with a parking offence.
NO
YES
If YES, please include details of the nature of the offence with which you are charged, date on which you were charged, and details of any on-going proceedings by a prosecuting body. |
4. Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you?
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the police. |
5. Are you aware of any current NHSScotland Counter Fraud Services investigation following allegations made against you?
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the NHSScotland Counter Fraud Services. |
6. Have you ever been investigated by the Police, NHSScotland Counter Fraud Services or any other Investigatory Body resulting in a caution, conviction or dismissal from your employment? (Investigatory bodies include Local Authorities, Customs and Excise, Immigration, Passport Agency, Inland Revenue, Department of Trade and Industry, Department of Work and Pensions, Security Agencies, Financial Service Authority, Banks and Building Societies, General, Life Insurance Companies – this list is not exhaustive, and you must declare any Investigation conducted by an Investigatory Body).
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the police/ investigatory body. |
7. Have you ever been dismissed by reason of misconduct from any employment, office or other position previously held by you?
NO
YES
If YES, please include details of the employment, office or position held, the date that you were dismissed and the nature of allegations of misconduct made against you. |
8. Have you ever been disqualified from the practice of a profession or required to practise subject to specified limitations following fitness to practise proceedings by a regulatory or licensing body in the United Kingdom or in any other country?
NO
YES
If YES, please include details of the nature of the disqualification, limitation or restriction, the date, and the name and address of the licensing or regulatory body concerned. |
9. Are you currently the subject of any investigation or fitness to practise proceedings by any licensing or regulatory body in the United Kingdom or any in other country?
NO
YES
If YES, please include details of the reason given for the investigation and/or proceedings undertaken, the date, details of any limitation or restriction to which you are currently subject, and the name and address of the licensing or regulatory body concerned. |
10. Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for the position for which you are applying?*
NO
YES
If YES, please include details of the nature of the prohibition, restriction, or limitation, when and by whom it was made. |
* include this question where the position involves regular contact with children in the normal course of the postholder’s duties or is a ‘regulated position’ under the provisions of the Protection of Children Act 1999 (as amended).
If you have answered ‘yes’ to any of the questions above, please use this space to
provide details. Please indicate clearly the number(s) of
the question that you are answering: |
Declaration
I have read the ‘Guidance Notes for Applicants’ that accompanied my application form, and I consent to the information provided in this Declaration Form being used by [organisation] for the purpose of assessing my application, and for enquiries in relation to the prevention and detection of fraud.
I confirm that the information that I have provided in this Declaration Form is correct and complete. I understand and accept that if I knowingly withhold information, or provide false or misleading information, this may result in my application being rejected, or if I am appointed, in my dismissal, and I may be liable to prosecution.
Please sign and date this form.
SIGNATURE__________________________________
NAME (in block capitals) _____________________________
DATE_________________________________
Note: if you wish to withdraw your consent at any time after completing this Declaration Form, please contact [insert details]
Employer Notes
This Model Declaration is intended for use only in
connection with positions that are
non-exempt from the Rehabilitation of Offenders Act 1974. Use of
this model declaration form is mandatory.
Model Declarations should be seen to complement existing good recruitment practice, and form part of the overall selection process. The Model Declaration is not a substitute for the full range of pre-appointment checks that are required by law or that are available to health bodies. It should be remembered that appointing persons on the basis of information that applicants have themselves provided can never be risk free.
NHS Employers has issued guidance concerning the Criminal Records Bureau available at www.nhsemployers.org .
Boards are expected to comply with the Data Protection Act 1998 when processing applications. For the purpose of this Model, it is presumed that Boards provide applicants with separate information [referred to for the purpose of this Model Declaration as ‘Guidance Notes for Applicants’] that reflects local procedures, to ensure that they deliver compliance.
Confidential
Before you can be considered for appointment in a position of trust with [organisation] we need to be satisfied about your character and suitability.
Please read the following notes carefully before completing this Declaration Form. If you require further information, please contact [insert details]. All enquiries will be treated in confidence.
[organisation] aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation, age. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other information declared.
Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe has a bearing on your suitability for the position. If we do not raise this information with you, this is because we do not believe that it should be taken into account.
In that event, you remain free to discuss any of that information or any other matter that you wish to raise. As part of assessing your application, we will only take into account relevant criminal record and other information declared.
The Data Protection Act 1998 requires us to advise you that we will be processing your personal data and, generally, to obtain your consent before processing personal data about you. Processing includes: holding, obtaining, recording, using, sharing and deleting information. The Data Protection Act 1998 defines ‘sensitive personal data’ as racial or ethnic origin, political opinions, religious or other beliefs, trade union membership, physical or mental health, sexual life, commission or alleged commission of offences and any proceedings for any offence committed or alleged to have been committed.
The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 1998, and may also be used for the purpose of determining your application for this position and may also be used for the purpose of enquires in relation to the prevention and detection of fraud. Once a decision has been made concerning your appointment, for successful applicants the declaration will be retained on their personal file, if unsuccessful, the declaration will be destroyed after 6 months. This declaration will be kept securely and in confidence, and access to it will be restricted to designated persons within the Health Board who are authorised to view it as a necessary part of their work.
Please ensure that you read the ‘Guidance Notes for
Applicants’ that accompanied your application form carefully
before completing this Declaration Form.
They provide you with further and more detailed information about
how your application will be processed, the persons to whom it will
be disclosed and the checks that will be done to verify the
information provided.
Please answer all of the following questions. If you answer ‘Yes’ to any of the questions, please provide full details in the space indicated.
Please also use the space below to provide any other information that may have a bearing on your suitability for the position for which you are applying. You may continue on a separate sheet if necessary, and you may attach supplementary comments should you wish to do so.
The position for which you have applied is non-exempt from the Rehabilitation of Offenders Act 1974. This means that you must declare any current, unspent convictions.
Answering ‘Yes’ to any of the questions below will not necessarily bar you from appointment. This will depend on the nature of the position for which you are applying and the particular circumstances.
1. Are you currently bound over or do you have any current ‘unspent’ convictions?
Note: You do not need to tell us about parking offences.
NO
YES
If YES, please include details of the order binding you over and/or the nature of the offence, the penalty, sentence or order of the Court, and the date and place of the Court hearing. |
2. Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?
Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you. You do not need to tell us if you are charged with a parking offence.
NO
YES
If YES, please include details of the nature of the offence with which you are charged, date on which you were charged, and details of any on-going proceedings by a prosecuting body. |
3. Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you?
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the police. |
4. Are you aware of any current NHSScotland Counter Fraud Services investigation following allegations made against you?
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the NHSScotland Counter Fraud Services. |
5. Have you been investigated by the police, NHSScotland Counter Fraud Services or any other investigatory body resulting in a current caution, conviction or dismissal from your employment? (Investigatory bodies include Local Authorities, Customs and Excise, Immigration, Passport Agency, Inland Revenue, Department of Trade and Industry, Department of Work and Pensions, Security Agencies, Financial Service Authority, Banks and Building Societies, General, Life Insurance Companies – this list is not exhaustive, and you must declare any Investigation conducted by an Investigatory Body).
NO
YES
If YES, please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the Investigatory Body. |
6. Have you ever been dismissed by reason of misconduct from any employment, office or other position previously held by you?
NO
YES
If YES, please include details of the employment, office or position held, the date that you were dismissed and the nature of allegations of misconduct made against you. |
7. Have you ever been disqualified from the practice of a profession, or required to practise subject to specified limitations following fitness to practise proceedings, by a regulatory or licensing body in the United Kingdom or in any other country?
NO
YES
If YES, please include details of the nature of the disqualification, limitation or restriction, the date, and the name and address of the licensing or regulatory body concerned. |
8. Are you currently the subject of any investigation or fitness to practise proceedings by any licensing or regulatory body in the United Kingdom or in any other country?
NO
YES
If YES, please include details of the reason given for the investigation and/or proceedings undertaken, the date, details of any limitation or restriction to which you are currently subject, and the name and address of the licensing or regulatory body concerned. |
9. Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for the position for which you are applying*?
NO
YES
If YES, please include details of the nature of the prohibition, restriction, or limitation, when and by whom it was made. |
If you have answered ‘yes’ to any of the questions above, please use this space to
provide details. Please indicate clearly the number(s) of
the question that you are answering: |
Declaration
I have read the ‘Guidance Notes for Applicants’ that accompanied my application form, and I consent to the information provided in this Declaration Form being used by [organisation] for the purpose of assessing my application, and for enquiries in relation to the prevention and detection of fraud.
I confirm that the information that I have provided in this Declaration Form is correct and complete. I understand and accept that if I knowingly withhold information, or provide false or misleading information, this may result in my application being rejected, or if I am appointed, in my dismissal, and I may be liable to prosecution.
Please sign and date this form.
SIGNATURE ______________________________
NAME (in block capitals) ____________________________
DATE ___________________________
Note: if you wish to withdraw your consent at any time after completing this Declaration Form, please contact [insert details]