I certify that the following answers are true and understand that if there are any omissions or false statements, my application will be refused or if a licence has been issued, it will be liable to immediate suspension or revocation.

I am aware that the grant of such a licence is subject to a criminal record check. This has been explained to me and I understand that the licensing authority does consider spent convictions. I hereby declare that the information given is true.

I certify that I am entitled to work within the United Kingdom and have the correct immigration status to apply for a licence. I understand that the licence will lapse if I cease to be entitled to work in the UK.

I agree that information in relation to my application may be shared with other directorates within Herefordshire Council. When appropriate Children's Services will interrogate their computer records for information which may be relevant in determining this application, any relevant information will be disclosed to the applicant and Panel Members if the application is referred to Officer Panel for determination.