Full Name

Mobile Number

Email Address

Please confirm you have been residing at the same address for the last 5 years (Please provide mm/yyyy that you moved in). If not, please provide us with the details of your previous address covering 5 years.

Have you changed your forename or last name?
NoYes

Which country and town were you born in?

Have you had your nationality changed?
NoYes

Do you have any convictions?
NoYes

Please supply two proofs of address. You may upload a copy of your driver's licence and a utility bill or council tax letter.

For a list of acceptable documents please see Group 2ab identity checking guidelines.

Payment Details

We require a payment of £35.50 for Standard or Basic DBS Certificate or £63.50 for Enhanced DBS Certificate to process your DBS. Please make payment to ORA365 LTD using the details below:

• Bank name: Barclays Bank

• Account name: ORA365 LTD

• Sort code: 20-19-97

• Account number: 03526356

• Reference: YOUR NAME

Please inform your compliance officer when payment has been made.

Application Consent

I authorise Care Check to use my personal data to carry out the following checks and understand the results will be communicated by Care Check to my employer SHR Group.

Standard/Enhanced (DBS) Check: I consent to a search for any spent and unspent criminal convictions (as defined in the Rehabilitation of Offenders Act 1974) obtained via the Disclosure and Barring Service (DBS).

I confirm that I have provided complete and true information in support of this application and understand that knowingly making a false statement for this purpose is a criminal offence. I acknowledge that if any information is submitted incorrectly, the DBS will withdraw the application and retain their fee.

I understand that if I do not provide authorisation for any of these statements, we must not proceed with this application.

Yes, I authorise and confirm the above

Disclosure and Barring Service (DBS) Privacy Policy

I have read the standard/enhanced check privacy policy for applicants, and I understand how the DBS will process my data and the options available to me for submitting an application.

Yes, I have read and understood the DBS Privacy Policy

Disclosure and Barring Service (DBS) Consent

I consent to the DBS providing electronic results directly to the registered body that submitted my application. I understand that an electronic result contains a message indicating either that the certificate is blank, or a "certificate on its way" message indicating that my certificate contains information. In some cases, the registered body may provide this information directly to my employer prior to me receiving a certificate.

I understand that if I do not consent to an electronic result being issued to the registered body submitting my application, I must not proceed with this application and should instead submit a paper application form.

I understand that to withdraw my consent while my application is in process, I must contact the DBS helpline on 03000 200 190. My application will then be withdrawn.

Yes, I consent to the above