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Broomwood / Self-declaration
Name

Please indicate whether any of the following statements apply to you

I have a criminal history.
I am prohibited from teaching.
I am prohibited from taking part in the management of an independent school.
I am known to the police and children’s local authority social care.
I have been disqualified from providing childcare.
For roles working with children under 8 years old, I am disqualified from working in these settings under the 2018 Childcare Disqualification Regulations.
I have committed a criminal offence in another country which would be considered a criminal conviction in line with the law as applicable in England and Wales, not the law in the country of origin or where I was convicted.
I have undertaken action, or have records held, overseas which make me unsuitable for working with children or young people.
Self Declaration
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