CARE STANDARDS ACT 2000

Voluntary/Childcare Approval Scheme Application 

Mae'r ffurflen hon hefyd ar gael yn Gymraeg/This document is also available in Welsh

Approval no	     	(For official use only)
     	
Current approval number (if renewal)	     		

WE’RE HERE TO HELP!

We hope that this form is easy to complete.  If you need any help or support, please do not hesitate to call our helpline on 0300 790 0126 or go to our website: www.CIW.org.uk The application form is in sections and you will need to complete all the sections.  

If you are using the electronic version please save to your computer and type in the relevant information.  Then print out the form, sign where indicated and send to the address at Llandudno Junction.  Please do not email the application form to CIW.  For the time being we can only receive applications in hard copy.

Please take your time to complete this form in handwriting that can reasonably be read by another person.  Thank you for your time. 

Section A – Your personal details:
National Insurance no:	     	Date of birth:
(Must be 18 years or over)	(dd/mm/bbbb)
     	

First names:	     	Title:	     	

Surname:	     	

Birth name:	     	

Present address and post code:	     	

Home telephone no: (with code)	     	

Mobile no:	     	

Daytime telephone no: (with code)	     	

Email address:	     	

Preferred language of communication 
for telephone calls: 
(please tick one box only)	Welsh
	
English

	

Preferred language of written communication: 
(including emails and letters) 
(please tick one box only)	Welsh
	
English
	
Both

	

Section B – Childcare and First Aid training
The criteria require that the applicant:

I.	has obtained one of the qualifications (below)  specified in the Social Care Wales List of Required Qualifications to work within the Early Years and Childcare Sector in Wales 

•	the Diploma in Children’s Care, Learning and Development (CCLD) (Wales & Northern Ireland) levels 3, 4 or 5 
or 
•	the CYPOP 5 unit – Understand how to set up a home based child care service.

II.	has obtained a paediatric first aid certificate within the 3 years prior to the application for approval independent of the criteria mentioned above. It must contain as a minimum the following areas: dealing with emergencies, resuscitation, choking, shock and anaphylactic shock in babies and children.
Details of training and qualifications
Details of first aid training and childcare qualifications received.

Please note: It is essential the date column is completed.

Training Establishment	Course/Qualification and level	Date
(dd/mm/yyyy)	
For Official Use Only	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

In order for us to proceed with the application, all elements of the above criteria must be met.  If it is obvious that the criteria have not been met, the application form will be returned to you with an explanation.  However, if you require a formal decision on your application please return the documents to us.  

Section C – Disclosure and Barring Service
Have you ever been convicted of a criminal offence
or cautioned or have any hearings pending?			Yes  	No  

If ‘Yes’ please give further information:
     	

As you will be working with children you should complete an enhanced Disclosure and Barring Service (DBS) check which will be sent to you. For more information you can go to their website: disclosure-and-barring-service 
If you already have an enhanced DBS certificate and are registered to the DBS Update Service in relation to this certificate, we will accept your DBS providing: 
•	Your certificate relates to the correct workforce area;
•	You meet the eligibility criteria for the level of check; 
•	You provide CIW with consent to carry out a status check on your DBS through the Update Service; and
•	You present your original DBS certificate to CIW.
Rehabilitation of Offenders Act 1974
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended) says that, for most purposes, and after a fixed time, people no longer have to declare their convictions

You should note however, that this application does not include a requirement to disclose offences. Disclosure and Barring Service checks will ensure that all relevant offences are included in the certificate issued by DBS.  Further information on the filtering out of old and minor offences is available from the Disclosure and Barring Service

Section D – Data Protection
Under the General Data Protection Regulation we are required to provide you with certain information and to seek your consent to the processing of personal data supplied by you on this form. This information includes how your personal information is handled, who your information is shared with, your rights in relation to your personal information and relevant people you may wish to contact in relation to any of this. This information is contained in the CIW Privacy Notice which is accessed by clicking here.

Please sign this declaration to indicate your consent to the processing by CIW of the data supplied by you on this form.
Applicant consent (C)
I have read and understood the CIW privacy notice and consent to CIW processing all or any personal data supplied by me on this form.

Signature:	     	Date:	     	
Applicant agreement (D)
Please sign below if you agree to the Childcare at Home Voluntary Approval Scheme releasing your information to your local Family Information Services (FIS) to allow parents to find out about Approved Home Childcarers available in their area.  

Signature:	     	Date:	     	

Section E – Validation of information
When you have completed your application and it has been checked to confirm that all the required criteria are met we will take payment. Following payment you will be sent an enhanced DBS disclosure form; you will be required to have your identity documents for the DBS check to be verified in any post office. Please send copies of your childcare and first aid training certificates to us along with the disclosure form.

If you are registered with the DBS Update service you will need to show us your original enhanced DBS certificate and provide us with your consent carry out a status check on your certificate through the Update Service.
Other relevant information not contained elsewhere:
     	
Applicant Declaration
I declare that all the information given is true and I understand that any false or misleading information may result in my application for approval being rejected.

Signature:	     	Date:	     	

Please print your name in capitals:	     	

Please return to:

Care Inspectorate Wales  
Government Buildings
Sarn Mynach
Llandudno Junction
LL31 9RZ
Payment details
Once you have submitted your application you will need to contact CIW on 0300 790 0126 to make payment over the phone. Please allow 5 working days before attempting to make payment for us to process your application.