CLL Suitability Declaration

Centre for Lifelong Learning Suitability Declaration Form 2025

Last reviewed: 4 November 2024

The University of Warwick has a responsibility for ensuring that all applicants for Centre for Lifelong Learning courses listed below are considered to be 'fit to practise' as set out in University Regulation 34Link opens in a new window.

Please complete this form so the University can consider your suitability for the aforementioned course. The information you put on this form will be considered in addition to your DBS disclosure.

The University will not use the information you declare on this form when it considers your academic suitability for the course you have applied for. However, before an offer of a place is made, the University will consider your fitness to practise in accordance with Regulation 34. Any false declaration may lead to your offer being withdrawn.

If you answer 'Yes' to any question, in the space provided you should give the details of the sanction, date, reason and identify the police force, authority, court or other body concerned.

Warwick ID

Full name

Email

Date of birth

Course

1. Have you ever been the subject of a bar, partial bar, warning or other sanction by the Secretary of State in relation to working with vulnerable adults, children, or misconduct?

If yes, please provide the full details below

2. Do you have any spent or unspent convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance?

The DBS filtering guidance is available on the DBS website.

Please note: An Enhanced DBS Check will disclose some spent convictions and cautions – if you have ever had a criminal record it is important that you check the above filtering guidance to see whether you need to declare a spent conviction or caution.

Failure to declare something that is later disclosed on your DBS Check will be viewed as dishonesty and may cause delays and impact your ability to take up your place on the course.

If yes, please provide the full details below

3. Have you ever been subject to any disciplinary sanction by any professional or regulatory body in this country or abroad, or are you currently the subject of investigation by such a body?

If yes, please provide the full details below

4. Is there a current employment disciplinary finding against you/or are you currently the subject of an employer’s disciplinary investigation?

If yes, please provide the full details below

5. Have you been barred from working with vulnerable adults, children in the UK or abroad?

If yes, please provide the full details below

6. Is there any other information the University should know about which may have a bearing upon your suitability to enrol for the course? (As a trainee or qualified Counsellor or Psychotherapist you will be responsible for upholding and promoting the ethical and professional standards of this profession. Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute.)

Please provide the details below

I declare that:

• All information I have provided on this form is complete and correct to the best of my knowledge and belief.

• I understand that the University may withdraw any offer of a place made to me if I have given false information or have withheld relevant details.

• I understand that the University may contact me about the information in my application and on this form and may seek further information from any police force, authority, court or other body I have named.

• I agree to tell the University as soon as reasonably practical about any changes to the information I have supplied above.

• I understand that the University will investigate any declaration I have made above in accordance with its Ordinances and Regulations (set out at https://warwick.ac.uk/services/gov/calendar), and with reference to the relevant statutory guidance.

By signing this form I confirm that I understand my responsibility to safeguard vulnerable adults, children and am aware that I must notify the University/my Programme Leader of anything I feel may affect my suitability.

Privacy notice

The University of Warwick will process the personal data provided on this form for the purposes of considering your fitness to practise in accordance with Regulation 34 - Determination of Fitness to Practise.

The data on this form will be used as part of our consideration. The date and time of your submission, and your identity (where submitted) will also be stored, but will not be used for any purpose other than administering this. Please see our Student Privacy Notice for further information.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

Spam prevention