disqualification, prohibition or restriction which takes effect as if contained in such a direction);
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 child minding or providing day care; or disqualified from registration under Part 3 of the
Childcare Act 2006.
I have not, in the five years prior to becoming a governor, received a sentence of imprisonment,
suspended or otherwise, 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 has 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, had passed on me a sentence of imprisonment for a period of not less than
I have not been fined, in the five years prior to becoming a governor, for causing a nuisance or
disturbance on education premises;
I am not subject to a disqualification order under the Criminal Justice and Court Services Act 2000.
The nature of the work for which you are applying means that you are exempt from Section 4 (2) of
the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.
You are not, therefore entitled to withhold information about any cautions or convictions which for other
purposes are “spent” under the provisions of the Act and, in the event of you being appointed to the post,
any failure to disclose such convictions could result in dismissal or disciplinary action by the Council.
It is a condition of your appointment as a school governor that you return this completed form to the
Governor Support Team. The information on the form will be considered and, if you have declared any
previous criminal convictions, these may be discussed with you prior to a decision being taken on your
Please be aware that the Authority has a policy on the recruitment of ex-offenders and that a criminal
record will not automatically debar anyone from being a Governor with the School/Council.