DBS Check Request

PART A — APPLICANT DETAILS

Full name: [Applicant Full Name]

Address: [Applicant Address]

Date of birth: [Date of Birth]

National Insurance number: [National Insurance Number, e.g. AB123456C]

PART B — POSITION DETAILS

Position applied for: [Position Title]

Employer/registered body: [Employer Name]

Level of check required:

[ ] Standard DBS check (Police Act 1997, s.113)

[ ] Enhanced DBS check (Police Act 1997, s.114)

[ ] Enhanced DBS check with barred list(s) (Police Act 1997, s.115; Safeguarding Vulnerable Groups Act 2006)

WORKFORCE (please tick all that apply):

[ ] Child workforce

[ ] Adult workforce

[ ] Other workforce

PART C — APPLICANT DECLARATION

I confirm that the information provided above is true and accurate to the best of my knowledge. I understand that:

1. The registered body will submit this application to the DBS;

2. The DBS will carry out a criminal record check under the Police Act 1997;

3. The resulting certificate will be sent to me at the address stated above;

4. Providing false information is an offence.

PART D — REGISTERED BODY USE ONLY

Registered body name: [Employer Name]

Countersignatory: _______________

NOTE: This is a template for guidance only. The official DBS application must be submitted online or via the paper form (DBS form). The level of check depends on the role. Standard and Enhanced checks are only available for roles eligible under the Police Act 1997 and Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Visit www.gov.uk/dbs for full guidance.