Sch 4Application to remove exclusion information from WCES database

Schedule 4—Application to remove exclusion information from WCES database

Regulation 43(2)

Social Services Regulation Act 2021

(Section 88(2))

Application to Remove EXCLUSION information from WCES Database

Applicant's details

Title:

Full name:

Residential address:

Postal address (if different):

Date of birth:

Telephone: Is a text telephone required? *Yes/*No

Interpreter required? *Yes/*No (if yes, please specify the language)

Exclusion decision

Date of exclusion decision:

Description of exclusion decision:

*Determination of Panel under section 79(1)(a) of the Act

*Interim exclusion under section 70 of the Act

*WWC exclusion or an interim WWC exclusion under the Worker Screening Act 2020

*Suspension of WWC clearance under section 79 of the Worker Screening Act 2020

*Suspension of registrations under section 2.6.27(2) of the Education and Training Reform Act 2006

*Cancellation of registrations under section 2.6.29 of the Education and Training Reform Act 2006

*Prohibition order made under section 132 of the Disability Service Safeguards Act 2018

Grounds for application

Specify the reasons why the information should be removed from the WCES database:

*Explain how your circumstances have changed since the information was placed on the WCES database and why you no longer pose an unjustifiable risk of harm to WCES service users.

OR

*The relevant disciplinary or regulatory finding was quashed or set aside on [specify date].

OR

*The relevant finding of guilt was quashed or set aside on [specify date].

Attach photocopies of any documents or references in support of your application (e.g. medical reports, counselling reports, employment history, training records, official report that the disciplinary or regulatory finding was quashed or set aside, court report of the decision quashing or setting aside the finding of guilt).

Applicant's signature:

Date:

*Delete if not applicable.