Candidate Declaration Form A

Guidance for applicants

Please read fully before completing this form.

When assessing your suitability for NHS appointments Calderdale & Huddersfield Foundation Trust is required to ask for certain information as part of our recruitment process, in accordance with the NHS Employment Check Standards.

These standards outline a range of checks that organisations in England must undertake when appointing to NHS positions. This includes information about criminal records and/or registration with any professional regulatory or licensing body (including investigations or formal action in relation to fitness to practise) as may be applicable to the role. It also includes obtaining employment history and/or other references which may provide information about any relevant conduct and/or behaviour that might need to be considered as part of our overall assessment of an applicant’s suitability for the position in question.

Asking applicants to complete a self-declaration enables us to have an open discussion, should we need to, to gain a better understanding about the circumstances surrounding any information disclosed. It also provides applicants with the chance to present any additional evidence they may wish us to consider in support of their application, and/or to ask questions, if anything is unclear. Should additional information be required, we will contact you to arrange a mutually convenient time to have a face to face meeting or discussion over the telephone.

Under normal circumstances, we will only ask successful applicants to complete model declaration form A once a conditional offer of appointment has been issued. We may require applicants to complete this form earlier in the recruitment process, where there is a safeguarding requirement for us to recruit quickly (for instance, to allow us to mitigate risks to patient services or care). Any requirements for you to complete this form earlier in the recruitment process will have been made clear to you when you first applied for this position.

Once we have received your completed form, we may be required to carry out a follow-up check with any relevant bodies such as the Disclosure and Barring Service (DBS), professional regulatory or licensing bodies, as may be appropriate to the role being applied for, and, in accordance with the NHS Employment Check Standards.

Important Information

The role you have applied for is exempt from the provisions normally afforded to individuals under the Rehabilitation of Offenders Act 1974. This means that we are required to obtain a standard or enhanced disclosure through the Disclosure and Barring Service (known as a DBS check) as defined under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended). It also means that you need to carefully consider the type of information you will need to declare when answering questions 1-4 in Model declaration form A (attached).

Before answering questions 1-4 you must ensure you read and understand the section about disclosing information about criminal record history below, which explains what information is required and signposts you to where you can seek free confidential and independent advice, if you are unsure.

Our fair recruitment promise

It is important for us to stipulate that answering YES to any of the questions in the attached form does not mean an automatic bar to being considered for a position in the NHS.

Calderdale & Huddersfield Foundation Trust is committed to treating all applicants equally and fairly based on their skills, experience and ability to fulfil the duties of the role being applied for. This is regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity, marriage or civil partnership.

Suitable applicants will also not be refused positions because of criminal record information or other

information declared, where it has no bearing on the role for which you are applying, and/or no risks have been identified against the duties you would be expected to perform as part of this role. The only exception to this rule is where there is a legal or regulatory reason which would prevent you from working or volunteering in certain positions. For instance, individuals who appear on the adults and/or children’s barred list(s) managed by the Disclosure and Barring Service (DBS) would be committing a criminal offence if they apply for a regulated activity from which they are barred from working or volunteering in. In such circumstances, it would also be illegal for an employer to allow that individual to engage in a regulated activity from which they are barred.

Failure to provide accurate and truthful information is considered a serious matter. If, as part of our checking process, it becomes apparent that an applicant has provided us with inaccurate information or they have not provided relevant information, we will need to discuss this with them to establish why. Any finding of serious misdirection or deliberate intent to deceive will result in their application being disqualified or disciplinary action and/or dismissal, if they are already in post.

If you have any questions or would like further advice about what information we might require as part of our recruitment process, please feel free to contact the Recruitment Team on Ask.Recruitmentcht.nhsuk All queries will be dealt with in strict confidence.

Disclosing criminal record information

When completing questions 1-4 in Model declaration form A (attached), you will need to declare all convictions that are not protected (i.e. eligible for filtering) as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended).

In April 2013, youth cautions and youth conditional cautions were introduced by the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO) to replace reprimands and final warnings. When completing this form, you will also need to declare all cautions and/or reprimands and final warnings which are not protected.

This includes any cautions and/or reprimands and final warnings that may have been issued in another country, where an equivalent offence in England and Wales is not protected.

Convictions, cautions, reprimands and final warnings must be declared regardless as to whether they are spent or are still considered unspent. This requirement applies to certain NHS positions which involve high levels of contact with children and adults who are receiving or accessing health and care services.

If the position is eligible for an enhanced disclosure, any subsequent check we carry out with the Disclosure and Barring Service (known as a DBS check) may include other relevant non-conviction information held on police databases, at the discretion of the Chief Constable of the relevant police force.

If the position you are applying for is a regulated activity as defined under the Safeguarding Vulnerable Groups Act 2006 (amended by the Protection of Freedoms Act in 2012), the enhanced disclosure may also include any information that is held about you on the children’s and/or adults barred list(s). As outlined in the section above, applicants must not apply for or engage in a regulated activity that they are barred from working or volunteering with.

Any criminal record information disclosed will be considered on a case-by-case basis. We will only take into

account information that is relevant to the position for which you are applying. This information will be balanced against the skills and competencies you have demonstrated throughout the recruitment process alongside other information we have obtained about you as part of our pre-employment check process.

If you declare information that is relevant to the role for which you are applying, we will also take into account:

  • the seriousness of the offence(s)
  • your age when you committed the offence(s)
  • the length of time since the offence(s) occurred
  • if there is a repeated or pattern of offending behaviour
  • the circumstances surrounding the offence(s)
  • any evidence you provide to demonstrate that your circumstances have changed since the offending behaviour.

This mirrors the Code of Practice issued by the Disclosure and Barring Service (DBS). Although the Code outlines what needs to be considered when criminal record information is disclosed as part of a DBS check, the NHS Employment Check Standards require employers to take the same approach when considering criminal record information that might be self-declared by applicants using model declaration form A (attached).

We appreciate that the criminal record disclosure regime is complex and difficult to understand, it is therefore essential for us to signpost applicants to where they can seek further information and advice about what may be included on their criminal record (if they have one), what they need to declare to any organisation they may be working or volunteering with, and their legal rights when doing so.

The following charities are experts in this field, offering free, independent and confidential advice to individuals who have a criminal record:

How will my information be used?

The information you provide using model declaration form A (attached) will be used for determining your suitability for the position you have applied for, and in accordance with the NHS Employment Check Standards. It will also be used for enquiries in relation to the prevention and detection of fraud.

Under the Data Protection Act 2018 and the General Data Protection Regulation 2018 (GDPR) organisations must provide you with detailed information which explains why certain information is required as part of the recruitment process, the lawful basis for collecting it, how it will be processed, and with whom information will be shared and under what circumstances. Please ensure that you read the supplementary guidance we provided when you first applied for this role as this explains how we may process your data and your rights under data protection laws. 

How will information be retained and for how long?

Once a recruitment (or other relevant) decision has been made, we will not keep any information declared in model declaration form A for any longer than is necessary. As a minimum this should be for a period of six months to allow for considerations and resolution of any disputes or complaints. There may be

circumstances where we are required to retain information for longer i.e. for the purpose of demonstrating safe recruitment practice as part of any scheduled safeguarding audits. 

Information will be held in accordance with the Data Protection Act, General Data Protection Regulation (GDPR) and the Human Rights Act. The form and any supplementary information provided by applicants with this form, will be kept securely and separately from any personnel records and access will be strictly limited to those who are entitled to see it as part of their duties, as outlined within our local policy on the correct handling and safekeeping of special categories of personal data. 

Once the retention period has elapsed, we will ensure that any information provided is destroyed by secure means, for example by shredding, pulping or burning. While awaiting destruction, the secure handling of information, as outlined above, will be adhered to. While the form and any supplementary information applicant’s chose to provide will be destroyed, we will need to keep a record of the date of when a self-declaration was requested/received, the position for which the self-declaration was requested, and the details of the recruitment decision taken.

Before completing this form, it is important to note the following points:

  1. You must answer all the questions in this form.
  2. Before ticking “yes” or “no” please ensure you read the explanatory notes underneath each question. These notes outline what information you should consider providing to support your answer.
  3. If you answer “yes” to any of the questions, please use the space provided to include any information that may be relevant to the position for which you are applying.
  4. If you would like to submit any additional supplementary evidence for us to consider in support of your application, please attach or upload this with the form when you return it to us.
  5. When answering questions 1-4 you are not required to disclose information about parking offences.
  6. You should notify us, at the earliest opportunity, if any information provided in this form subsequently changes once you have submitted it to us and before taking up the appointment. 

On completion of the form the form is emailed to the email address provided.  Please print off and sign a copy of the form.  Signed forms need to be returned to ask.recruitmentcht.nhsuk or Recruitment Department, Calderdale & Huddersfield NHS Foundation Trust,  Acre Mill, Huddersfield, HD3 3EB (01484 355002). 

Candidate Declaration Form A

Applicant Details
It also includes all convictions or Summary Hearings that have been issued under military law while serving in the Armed Forces, either in the UK or any other country, where the equivalent offence in England and Wales is not protected.

You are not required to disclose any information in relation to the above if ALL convictions are protected (i.e. eligible for filtering) as outlined in the Exceptions Order. In these circumstances you should tick NO to this question.

This requirement is regardless as to whether any conviction is spent or remains unspent.

Please ensure that you read guidance in the section on disclosing criminal history information before completing this question.

If you have ticked YES, you now have two options on how to disclose this information.
It also includes all cautions, reprimands or final warnings that have been issued under military law while serving in the Armed Forces, either in the UK or any other country, where the equivalent offence in England and Wales is not protected.

You are not required to disclose any information in relation to the above if ALL convictions are protected (i.e. eligible for filtering) as outlined in the Exceptions Order. In these circumstances you should tick NO to this question.

This requirement is regardless as to whether any caution, reprimand or final warning is spent or remains unspent.

Please ensure that you read guidance in the section on disclosing criminal history information before completing this question.

If you have ticked YES, you now have two options on how to disclose this information.
This includes where you have been formally charged of any offence that has been issued in any other country which has not yet been disposed of.

Please note that you must inform us immediately if you are formally charged with any offence after you complete this form and before taking up any position offered to you.
This may also include any current criminal investigations or pending prosecutions by the police in any other country.
Any other investigatory bodies may include: HM Revenue & Customs, Financial Services Authority, Department for Business, Energy and Industrial Strategy (formerly the Department of Trade & Industry), Local Authorities, Department of Work and Pensions, Home Office, and UK Visas and Immigration.

This list is not exhaustive and should be taken as a guide only. You must declare any action taken against you by an investigatory body, following allegations of fraud.
This may include any fitness to practise investigation and/or proceedings of any nature that are being undertaken by a regulatory or licensing body in any other country.
You are not required to disclose any information in relation to the above where any right to appeal has been upheld and where that appeal has resulted in your case being fully exonerated. In these circumstances you should tick NO to this question.
Declaration
The Data Protection Act 2018 and General Data Protection Regulation 2018 (GDPR) requires us to provide you with detailed information which explains the lawful basis for collecting special categories of personal data (previously known as sensitive personal data), how it will be processed, who information will be shared with and under what circumstances.

The General Data Protection Regulation defines special categories of personal data as racial or ethnic original, political opinions, religious or philosophical beliefs, trade union membership, genetic data, biometric data, data concerning health or data concerning a natural person’s sex life or sexual orientation. It also includes data relating to criminal convictions, criminal offences or related security measures. It is important that you read the supplementary guidance we provided at the time of your application, which explains our policy on the retention and erasure of any such information in greater detail. This information also outlines your rights under the data protection and human rights laws.

The information you provide using model declaration form A will be processed in accordance with data protection law, as described above. It will used for the purpose of determining your suitability for the position you have applied for, in accordance with the NHS Employment Check Standards. It will also be used for enquiries in relation to the prevention and detection of fraud.

Once a recruitment (or other relevant) decision has been made Calderdale & Huddersfield Foundation Trust will not keep any information declared in this form for any longer than is necessary. As a minimum this will be for a period of six months to allow for considerations and resolution of any disputes or complaints. There may be circumstances where we are required to retain information for longer i.e. for the purpose of demonstrating safe recruitment practice as part of any scheduled safeguarding audits.

The form and any supplementary information provided by applicants with this form, will be kept securely and separately from any personnel records and access will be strictly limited to those who are entitled to see it as part of their duties, as outlined within our local policy on the correct handling and safekeeping of special categories of personal data.

Once the retention period has elapsed, we will ensure that any information provided is destroyed by secure means, for example by shredding, pulping or burning. While awaiting destruction, the secure handling of information, as outlined above, will be adhered to.

While the form and any supplementary information applicant’s chose to provide will be destroyed, a record will be retained of the date of when a self-declaration was requested/received, the position for which the self-declaration was requested, and the details of the recruitment decision taken.

If you need any assistance or advice before returning this form to us, or you wish to withdraw your consent at any time after you have submitted this form, please contact Ask.Recruitment@cht.nhs.uk

All enquiries will be treated in strict confidence.

In submitting this form, you are agreeing to the following statements:

1. I confirm that I have read and understood guidance provided to me which explains how my data will be processed and give my consent for enquiries to be made, as outlined.

2. I declare that the information I have provided in this form and in any accompanying documentation, is true to the best of my knowledge and belief.

3. I understand and accept that if I knowingly withhold relevant information or provide false or misleading information, this may result in my application being rejected; or, if I am appointed, my dismissal; and, where applicable, this may result in the employing organisation making a referral to any relevant regulatory or licensing body.

4. I agree to notify the employing organisation of any subsequent change to the information supplied in this form before I take up appointment.

Form last reviewed:09/08/19

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