DBS Disclosure Application Form

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PERSONAL DETAILS

Name(Required)
MM slash DD slash YYYY

PLACE OF BIRTH

Have you changed your nationality since birth? If 'yes' please state nationality at birth.(Required)
Have you changed your birth surname?(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

ADDRESS DETAILS

Have you ever been convicted of a criminal offence or given a caution, reprimand or final warnings in accordance with the rehabilitation of offenders (exceptions) act 1979? All convictions must be disclosed (not including traffic offences)(Required)
If ‘yes’ please ensure full details have been recorded on your application form. By completing this form, I acknowledge and consent that, M G Care Executive Limited t/a uCheck, may collect and/or receive and/or process certain personal information and data about me. I understand that all of my information (including my personal data) will be collected and processed in accordance with the Data Protection Act 2018, and the General Data Protection Regulations 2016, and UCheck Terms of Use, your Statement of Fair Processing Policy and your Privacy Policy.
DBS Statement of Fair Processing.(Required)
The Disclosure and Barring Service will refer the details provided on this form to government and law enforcement bodies in accordance with any relevant legislation. The details provided to these bodies will be used for identifying possible matches to records held by them. Where such a match is established, data may be released to the DBS for inclusion on any certificate issued. The details provided on this form may be used to update the records held by the bodies specified above. The details provided on the application form may be used to verify my identity for authentication purposes. The DBS may use any information provided by the DBS on a certificate or otherwise held by the DBS to inform any of its barring decisions made under its powers within the Safeguarding Vulnerable Groups Act 2006. v9.0. I agree and consent to the personal information that I provide being processed for the following purposes: Disclosure and Barring Service (Enhanced Check). I understand the exact processing of my personal information will depend upon the requirements of my employer. I agree and consent to my personal information being processed by yourselves for any or all of the purposes listed above (if required) by my employer. I understand you will delete any information that I have provided that is not required for processing. I understand that I have provided complete and true information in support of my application and that I understand that knowingly making a false statement for this purpose is a criminal offence. I understand that Homecarers Ltd have been authorised to access this service by virtue of a contract between you and my employer and that my failure to comply with your Terms of Use , your Statement of Fair Processing Policy and your Privacy Policy will cause my employer to be in breach of contract. I consent to, M G Care Executive Limited t/a uCheck receiving an electronic notification once the application has been processed which states either the ‘Certificate contains no information’ or ‘Please wait to view applicant certificate’. I understand that I may withdraw this consent at any time by giving written notice to M G Care Executive Limited t/a uCheck by emailing M G Care Executive Limited t/a uCheck at the following email address: governance@ucheck.co.uk. I have read and understood this statement (check to confirm).
Signature of applicant (Type Your Name)
Date of signature.