DECLARATION FORM

MADISON REIGN

Candidate's Name

DBS DETAILS

DBS Number

Issue Date

Is DBS on Update Service?

YES

Are you currently subject to any criminal investigation or unresolved misconduct allegation?

YES

I give Madison Reign Ltd permission to check my certificate status online on a regular basis to confirm whether or not my DBS Disclosure shows any additional information.

DBS Privacy Policy Only applicable for individuals applying for a DBS I have read the Standard/Enhanced Check Privacy Policy for applicants and I understand how the DBS will process my personal data and the options available to me for submitting an application.https://www.gov.uk/government/publications/dbs-privacy-policies

PAYMENT METHOD

Are you registered with an Umbrella company?

YES

If yes please specify which company.

Do you give permission for Madison Reign Ltd to share your contact information with Marquee Umbrella?

YES

PROFESSIONAL CONDUCT

Anyone applying for employment in a school in a capacity involving contact with children under the age of 18 is exempt from the provisions of the rehabilitation of offenders’ act 1974 by virtue of the rehabilitation of offenders act 1974 (exceptions) (amendments) order 1986. The agency worker is, therefore, not entitled to withhold information about convictions, cautions or additional information which for other purposes are 'spent' under the provisions of the act and, in the event of being placed in an assignment, any failure to disclose such convictions could result in the termination of the assignment.

Have you ever been convicted of a criminal offence which is spent or unspent under the Rehabilitation of Offenders Act 1974?

YES

If yes, please list your criminal convictions and their dates.

Do you have any record of professional misconduct proceedings or investigations from an employer, either in the UK or overseas?

YES

If yes, please give details:

DATA PROTECTION

May Madison Reign Ltd use your photo for vetting purposes? (Madison Reign Ltd are required to supply schools with your photo for vetting purposes)

YES

May Madison Reign Ltd use your photo for marketing purposes? (Madison Reign Ltd market teachers with their photo on candidate profiles in mail-shots/e-shots, and brochures, amongst other marketing material)

YES

May Madison Reign Ltd use your CV for marketing purposes? (Madison Reign Ltd are required to supply schools with your CV to help find suitable positions)

YES

GENERAL DATA PROTECTION REGULATION (GDPR)

Madison Reign Ltd is a recruitment business which provides work-finding services to its clients and work-seekers. Madison Reign Ltd must process personal data (including sensitive personal data) so that it can provide these services – in doing so, Madison Reign Ltd acts as a data controller. You may give your personal details to Madison Reign Ltd directly, such as on an application or registration form or via our website, or we may collect them from another source such as a jobs board. Madison Reign Ltd must have a legal basis for processing your personal data. For the purposes of providing you with work-finding services and/or information relating to roles relevant to you we will only use your personal data in accordance with GDPR. For more information please check the Privacy Notice on our website.

DECLARATION

I declare that to the best of my knowledge all the information I have given is correct. I understand that false information could lead to police investigation, removal from Madison Reign Ltd.’s database and termination of my contract. I declare that I have read Madison Reign Ltd.’s Terms of Engagement and that by signing this declaration I agree to everything therein. I agree that my registration will only be complete on the receipt of satisfactory references and a cleared check from the Criminal Records Bureau. I authorise Madison Reign Ltd to use my photograph, for marketing purposes unless I have indicated otherwise on this form. I agree to Madison Reign Ltd holding all personal information received about me on file and agree to update Madison Reign immediately if any information provided here changes.

Full Name of Candidate

Date of Form Completion

By ticking this box I am signing a declaration of all answers on this form to be correct.