INFORMATION REQUIRED FOR DISCLOSURE BARRING SERVICE CHECK

(BASIC DBS)

Please can you complete ALL the below sections accurately.
Any information that is not completed correctly will delay obtaining your DBS.

Personal Details

Current Details

Your Full Name(Required)

Title First Middle Last

Gender(Required)

National Insurance Number(Required)

Birth Details

Date of Birth(Required)

Birth Nationality(Required)

County of Birth(Required)

Town of Birth(Required)

Has your nationality changed since birth?(Required)

Yes

Have you ever been known by any other name?(Required)

Yes

Previous name

Used from (month / year)

Used until (month / year)

If you have been known by any other names please provide details in the space below:

Address Details

Details of ALL addresses covering the last 5 years in date order (most recent first)

Current Address(Required)

First Line of Current Address Second Line of Address City Postcode

Date Moved In (mm/yy)(Required)

Previous Address

First Line of Previous Address Second Line of Address City Postcode

Date Moved In (mm/yy)

Additional Addresses

If you need to add more addresses please use this section

Address	Date Moved In (mm/yy)	Actions

There are no Addresses.

Authorisation of deduction from wages for BASIC Disclosure Barring Service (DBS)

I (Insert name)(Required)

...hereby agree for KSB Recruitment Consultants Ltd to apply for an

BASIC DBS and deduct £36.20

from my next wages due. Should sufficient funds not be available in my next pay week, I agree for the money to be deducted when there are.

I understand that no refund will be permitted once the DBS has been applied for, however, I do have the right to non-deduction of wages if any of the DBS hasn’t been applied for.

I am aware that KSB will post the DBS certificate to the latest address I provided them.

Your Name(Required)

Your Email(Required)

Your Signature(Required)

Date(Required)