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17. In respect of any person, other than the applicant, who works at, or is intended to work at the establishment or for the purposes of the agency –
(a)whether the person is, or is intended to be, resident in the premises used as the establishment or for the purposes of the agency;
(b)if he is a relative of any person who has made an application in respect of the establishment or agency, his relationship to such person;
(c)whether the person works or is intended to work, on a full-time basis or on a part-time basis and, if on a part-time basis, the number of hours per week for which it is intended that the person will work;
(d)the date on which the person commenced, or is intended to commence, working at the establishment or for the purposes of the agency;
(e)information as to the person’s qualifications, experience and skills in so far as is relevant to the work that the person is to perform;
(f)a statement by the applicant that he is satisfied as to the authenticity of the qualifications, and has verified the experience and skills that are referred to in sub-paragraph (e);
(g)a statement as to –
(i)the suitability of the person’s qualifications for the work that the person is to perform;
(ii)whether the person has the skills necessary for such work;
(iii)the person’s fitness to work, and have regular contact, with service users;
(h)a statement by the person as to the state of his physical and mental health;
(i)a statement by the applicant that the person is physically and mentally fit for the purposes of the work which he is to perform;
(j)a statement by the applicant as to whether he is satisfied as to the person’s identity, the means by which he so satisfied himself and whether he has obtained a copy of the person’s birth certificate;
(k)confirmation by the applicant that he has a recent photograph of the person;
(l)a statement by the applicant that he has obtained two references relating to the person and that he is satisfied as to the authenticity of those references;
(m)details of any criminal offences of which the person has been convicted, including details of any convictions which are spent within the meaning of the Rehabilitation of Offenders (Northern Ireland) Order 1978 and which may be disclosed by virtue of the Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979, and, in relation to each such offence, a statement by the person –
(i)as to whether in his view the offence is relevant to his suitability to care for, train, supervise or be in sole charge of any person and, if so,
(ii)as to why he considers that he is suitable to perform the work in which he is to be employed;
(n)details of any criminal offences in respect of which he has been cautioned by a constable and which, at the time the caution was given, he admitted.
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