Parent Governor - Pre Appointment Check Form

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The information you give on this form will enable your eligibility to serve as a governor to be established. As a governor, the Headteacher will ask you to undertake a DBS enhanced check. This measure is to ensure the safety of children.

Your responses will be securely saved in the Schools Education G-Drive - any questions please do contact the school

Email *

Your Full Name *

Your Home Address *

Home or Mobile Telephone *

Proof of Identity that I can provide *

Driving Licence

Passport

Birth Certificate

Required

Declaration of Eligibility *

I declare that I am not disqualified from serving as a school governor and that:

I am aged 18 or over at the date of this election or appointment

I do not already hold a governorship of the same school

I have not had my estate sequestrated and the sequestration has not been discharged, annulled or reduced

I am not subject to a bankruptcy restrictions order, an interim bankruptcy restrictions order, a debt relief restrictions order or an interim debt relief restrictions order

I am not subject to a disqualification order or disqualification undertaking under the Company Directors Disqualification Act 1986, a disqualification order under the Company Directors Disqualification (Northern Ireland) Order 2002, a disqualification undertaking accepted under the Company Directors Disqualification (Northern Ireland) Order 2002 or an order under Section 429(2)(b) of the Insolvency Act 1986

I have not been removed from the office of trustee for a charity by an order made by the Charity Commission or the High Court on the grounds of any misconduct or mismanagement in the administration of the charity or under Section 34 of the Charities and Trustee Investment (Scotland) Act 2005, from being concerned in the management or control of any body

I am not included in the list of people considered by the Secretary of State as unsuitable to work with children

I am not disqualified from working with children or subject to a direction under Section 142 of the Education Act 2002

I am not barred from regulated activity relating to children in accordance with Section 3(2) of the Safeguarding Vulnerable Groups Act 2006

I am not disqualified from working with children under Sections 28, 29 or 29A of the Criminal Justice and Court Services Act 2000

I am not disqualified from registration under Part 2 of the Children and Families (Wales) Measure 2010 for childminding or providing day care

I am not disqualified from registration under Part 3 of the Childcare Act 2006

I have not, in the five years prior to becoming a governor or since becoming a governor received a sentence of imprisonment (whether suspended or not) for a period of not less than three months (without the option of a fine

I have not, in the twenty years prior to becoming a governor, been convicted as aforesaid of any offence and had passed on me a sentence of imprisonment for a period of not less than two and a half years

I have not, at any time received a prison sentence of five years or more

I have not been convicted for causing a nuisance or disturbance on school premises during the five years prior to or since appointment or election as a governor

I have not refused a request by the clerk to the governing body to make an application to the Criminal Records Bureau for a criminal records certificate

Required

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