GLHA
Offence Declaration Form
I ________________ declare that I have not been charged or convicted of any criminal offence during the period of September (previous year) and September (previous year).
I will report any charges and/or convictions during the period of September (Year to be entered) and September (year to be entererd) to the Director of Risk Management of the GLHA.
The GLHA will treat any information supplied in a confidential manner and the material will only be made available on a need-to-know basis to the Ethics and Discipline Committee.
The signor agrees that the information supplied in this document and the Police Records Check may be used as part of the selection process for a volunteer position with the London Bandits.
Signed ________________ Dated _______________