RTÉ Child Protection Policy and Procedures...

APPENDIX 5
RTÉ Child Protection Personal Disclosure Form
Name:
Department/IBD:
Job Title:
Immediate Senior Line Manager:
Date of Birth:
Address:
I, the undersigned, have at no time been convicted of any offence relating to children
or young persons; and/ or subject to any disciplinary action or sanction relating to
children or any sanction which restricts me from working with children.
Signed:
Dated:
20