I certify that the information on this form is correct and complete to the best of my knowledge. I am not on List 99, disqualified from work with children, or subject to sanctions imposed by a regulatory body.

I understand my responsibility to safeguard children and am aware that I am required to notify the head teacher of anything that may affect my suitability.

I give permission for you to contact any previous employers, police and the DBS to share information about my suitability to care for children.

I certify that to the best of my knowledge all the information I have given is correct. I understand that by deliberately giving false or incomplete information I may be suspended from duty and may be liable to summary dismissal with possible referral to the police.

I also understand that, on appointment, the information from this form may be computerized for personnel purposes in accordance with the Data Protection Act.