University College Plymouth St Mark & St John

Your completed CRB Disclosure application form will be scanned by the CRB and sent back if it has not been completed correctly.  Please make sure that you follow these instructions.  Failure to do so will either result in a delay in your form being sent to the CRB or it will be returned by them.

• Use BLOCK CAPITALS
• Use black ink
• Do NOT USE CORRECTION FLUID ie Tippex
• If you make a mistake, cross through with one horizontal line and write the correct information to the right and as close to the original point as you can without overlapping any other text
• Do NOT write outside of the boxes provided unless it is an amendment
• ONLY put one letter/number in each character box provided
• Do NOT use ticks or other symbols.  Where relevant mark box with a X
• Do leave a space between words where possible but not between numbers and postcodes

• ONLY complete Sections A, B, C, D and H
• Do NOT complete Sections E, F, G, X, Y and Z

Please complete your application form as follows:

Section A

• Complete LINES 1-12
• Do NOT forget LINE 8/9 Date at Current Address
• Do NOT FORGET line10/11 Gender – Male or Female
• If you cross Ms or Other, please insert your surname in Section C LINE 20
• If you cross Mrs, please insert your maiden name in Section C LINE 20
• Please include all middle names

Section B

LINE 13 Please leave blank – we will complete this
LINE 14 UCP MARJON
LINE 15 DERRIFORD ROAD
LINE 17 PLYMOUTH
LINE 18 DEVON
LINE 19 PL6 8BH

Section C

LINES 20-26/27 Only to be completed if you have been known by a different name(s) at any stage or if you have crossed Ms, Mrs or other in Section A
LINES 28-35 Must be completed by all applicants even if your country of birth is not UK

Section D

LINES 36-42/45 The CRB requires details of all your addresses for the previous 5 years.  Use this section if the Date at Current Address (Section A) does not cover 5 years.  If you require more space, please use the provided continuation sheet.  Make sure that dates do not overlap and that there are no gaps between dates you were at different addresses.  Include postcodes.  If you were travelling abroad, please put the dates and the country(ies) visited.  If you require extra continuation sheets please click here.

DO NOT COMPLETE SECTIONS E, F OR G

Section H

LINE 66 Must be completed by all applicants
LINE 67 Only cross this box if you have provided a continuation sheet(s)
LINE 68 Must be signed by all applicants.  Do NOT go outside or overlap the box
LINE 69 Do NOT complete
LINE 70 Please enter the date you completed the form

DO NOT COMPLETE SECTIONS  X, Y or Z

If you have any queries, please email crb@ucpmarjon.ac.uk, or telephone 01752 636890.

Completing this form incorrectly will result in a delay in processing and could affect any placements required by your course.  Please check your form carefully before returning it within one month of receipt to:

CRB
Registry Office
University College Plymouth St Mark & St John
Derriford Road
Plymouth PL6 8BH

together with a cheque for £36.00 payable to UCP Marjon.  Please write the name of the applicant in block capitals, CRB and their student number on the reverse of the cheque.