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DBS Check Request Form

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Applicant Last Name*

Applicant First Name*

Applicant Middle Name(s)

Applicant Date of Birth (DD/MM/YYYY)*

Applicant Email Address*

Applicant Address 1st Line*

Applicant Postcode*

Recruiting Manager Name*

Recruiting Manager Email Address*

ID Checker Name

ID Checker Email Address

Benefice Number*

Diocese*

Level of Disclosure Required*

Position applied for*

Workforce*

Is the position a regulated activity with children, i.e. an activity that requires a check of the children’s barred list?*

Yes

No

Is the position a regulated activity with adults, i.e. an activity that requires a check of the adults’ barred list?*

Yes

No

Does this position involve working with children or adults at the home address of the applicant?*

Yes

No

Is the application for an unpaid volunteer?*

Yes

No

Has a thorough risk assessment indicated that this criminal record check is both proportionate and relevant to the position concerned?*

Yes

No

Name of Person Submitting Form*

The Church in Wales 2 Callaghan Square Cardiff CF10 5BT

029 2034 8200