Candidate Self-Disclosure

Personal Information

Name *

Email

Phone Number

Release Date

Community License Start Date (if applicable)

Community License Duration (if applicable)

Restrictions

Tick all that apply & please provide details where relevant.

Standard Conditions

Keep in contact / receive visits with probation staff

Live at an approved address

Notify changes in circumstances (address, employment, relationship, travel, etc.)

Not travel abroad without permission

Not interfere with victims or witnesses

Residence & Movement Restrictions

Curfew

Approved premises / hostel requirement

Exclusion zones (specific areas, streets, towns)

Restrictions on overnight stays or visitors

Contact Restrictions

No contact with named individuals (victims, co-offenders etc.)

Restrictions on forming new relationships (e.g. informing probation)

No unsupervised contact with children or vulnerable people

Work & Activity Restrictions

Restrictions on certain types of employment (e.g. working with children, financial roles, lone working)

Requirement to disclose conviction to employers in some cases

Structured activity requirements (courses, unpaid work, programmes)

Programme / Rehabilitation Requirements

Attendance at accredited programmes (e.g. thinking skills, domestic abuse)

Substance misuse treatment (drug/alcohol testing or treatment)

Mental health treatment requirements

Technology & Communication Restrictions

Limits on internet use or device ownership

Monitoring software on devices

Restrictions on social media or messaging platforms

Behavioural Controls

Alcohol restrictions or bans

Requirement to avoid certain venues (e.g. pubs, clubs etc.)

Anger management or behavioural compliance conditions

Reporting & Monitoring Enhancements

Increased reporting frequency

Electronic monitoring (GPS tag)

Polygraph testing

Travel & Association Controls

Restrictions on entering certain locations (e.g. schools, parks etc.)

Limits on associating with certain groups (e.g. gangs etc.)

Limits on vehicle usage

Do you have any special education needs, mental health difficulties (anxiety, depression etc.) or a history of substance misuse?

Could any of the issues listed above limit where you can work? (if yes, please provide details)

Factors that may lead to repeating offences or criminal activity?

Are there any reasonable adjustments required for you to be successful in your placement? (including any long-term physical health difficulties/disabilities)

Are you supported by any other agencies? If yes, please list below. (e.g. MAPPA, social services, third sector)

Please provide any other relevant information (if applicable)