HOUSE TO HOUSE COLLECTION ACT 1939
DECLARATION
Surname
all Forenames
Maiden name
Previous Surnames
Present address
Post code
Age
Telephone number
Date of Birth
Place of Birth
Sex M/F
HAVE YOU BEEN CONVICTED FOR ANY OFFENCE SHOWN BELOW WHICH IS NOT NOW 'SPENT' UNDER
THE TERMS OF THE REHABILITATION OF OFFENDERS ACT 1974 (see table overleaf) OR HAD A FORMAL
CAUTION RECORDED AGAINST YOU WITHIN THE LAST THREE YEARS FOR ANY OFFENCE SHOWN
BELOW.
Offences under section 47 to 56 of the Offences against the Persons Act 1861;
Robbery, Burglary, Blackmail under the Theft Act 1968;
Offences in Scotland involving personal violence or lewd, indecent or libidinous conduct, or
dishonest appropriation of property;
Offences under the Street Collections Regulation (Scotland) Act 1915;
Offences under section 5 of the Police, Factories, etc (Miscellaneous Provisions) Act 1916.
If yes provide details below including date, offence and the court or body which dealt with you. If you
knowingly or recklessly make a statement false in a material particular you will be liable to a fine not
exceeding level 3 on the standard scale or imprisonment for a term not exceeding 6 months or both. If you
fail to provide details as requested then your application may be refused.
Date of conviction/ Caution
(Including Police Force)
Offence
Sentence (including
suspended sentences)
If no convictions or cautions enter NIL
Date…………………….…………………….. Signed………………………………………………….
SEE OVER
REHABILITATION OF OFFENDERS ACT 1974
SENTENCE
Absolute Discharge
Probation order in respect of
persons convicted before
03/02/1995, supervision order
conditional discharge or bind
over
Probation order on or after
03/02/1995
Attendance centre order
Hospital order under Mental
Health Act
BECOMES
SPENT AFTER
6 months
1 year from date
of conviction or
until order expires
whichever is later
5 years
1 year after expiry
5 years from date
conviction or 2
years after order
expires
SENTENCE
Imprisonment (including suspended
sentence) of between 6 months and 2
½ years (including cashiering,
dismissal with disgrace, discharge
with ignominy from Armed Forces)
Imprisonment (including suspended
sentence) of up to 6 months (includes
dismissal from Armed Forces and
Borstal Training)
Fine or other sentence not otherwise
covered in this table e.g. CSO Curfew
Detention under S53 Children &
Young Persons Act between 6 and 30
months
Detention of less than 6 months under
the above provisions
N.B. A sentence of more than 2 ½ years can never become spent.
Halve above if under 18 when convicted.
BECOMES
SPENT AFTER
10 years
7 years
5 years
5 years
3 years