Have you ever been the subject of a disciplinary investigation / proceedings or had a Barring List referral made?* —Please choose an option—YesNo
If yes, please provide details:

The position you have applied for has been identified as being an ‘eligible position’ under the Rehabilitation of Offenders Act 1974 (Exceptions) order 1975 {the Exceptions Order} and, in certain circumstances, the Police Act 1997. As such, it meets the eligibility criteria for a standard or an enhanced disclosure to be requested through the Disclosure and Barring Service (DBS).
Please be aware that the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013 (S.I. 2013/1198) made amendment to the 1974 Act to provide that certain convictions and cautions will become protected when specific conditions are met. Protected convictions and cautions will not be disclosed in a DBS check, and employers cannot ask for information about protected convictions or cautions or take these into account when considering your appointment.
Before you complete this section please read guidance for the filtering of these convictions and cautions which can be found on the disclosure and Barring Service web site at:
https://www.gov.uk/government/organisations/disclosure-and-barring-service
Any information given is confidential. As the recipients of disclosed information, Potens will ensure to keep such information secure and protect it against loss or unauthorised access. It is your responsibility to keep Potens up to date with any changes to your circumstances throughout the recruitment process, and any employment with Potens.

Are you currently bound over, or do you have any convictions or cautions (including warnings and reprimands) which are not deemed ‘protected’ under the amendment to the Exceptions Order 1975*, issued by a Court or Court Martial in the United Kingdom or in any other country?
—Please choose an option—YesNo

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):

Have you ever been issued with a caution, reprimand or warning (issued by a Court or the police)?
Please note that you do not need to tell us about convictions, cautions warnings or reprimands which are deemed ‘protected’ (see above). You are also not required to tell us about parking offences.
—Please choose an option—YesNo

If yes, please provide details:

Do you have any convictions pending that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013 by SI 2013 1198)?
—Please choose an option—YesNo

If yes, please provide details:

Have you ever been involved in a criminal investigation (whether or not this led to any prosecution that would not be “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013 by SI 2013 1198)?
—Please choose an option—YesNo

If yes, please provide details:

I declare that all the information given in application for this post is true and complete. I understand that if it is subsequently discovered that any particulars I have given are false or misleading, I may be regarded as ineligible for recruitment or liable to be dismissed.
I understand that details contained on this form may be held on computer or form the basis of manual records. In applying for this post, I understand that data contained on this form may be used to produce depersonalised statistics in connection with Equal Opportunities and recruitment monitoring.

Please tick this box if you agree with the above statements:
Are you are are over the age of 18? —Please choose an option—YesNo

Please note applicants will be required to complete a full application form if shortlisted.