Password (please type it twice) *

First Name *

Last Name *

Title *
Prof.Dr.Mr.Mrs.Ms.

House *

Street *

Town *

County *

Post Code *

Region *
South WestSouth EastLondonWalesScotlandMidlandsNorth WestNorth EastNorthern IrelandChannel IslandsIsle of Man

Phone *

Email *

Public Phone Number *

Public Email Address *

Job Title *
University LecturerABA Case Manager/Consultant in AutismABA Programme Supervisor in AutismABA Tutor/Therapist in AutismPractitioner/Consultant in Learning DisabilityTutor/Therapist, Behaviour Support in Learning DisabilitiesPractitioner/Consultant in Business or IndustryPractitioner/Consultant in Mainstream EducationTutor, Teaching Assistant, Learning Support AssistantStudent

Autism *

Mainstream Education *

Learning Disabilities (Adult) *

Organisational Behaviour Management *

Learning Disabilities (Children) *

Other

Qualification

About Me *

Offering Supervision *
Yes   No

I am available for work *
Yes   No

I have a current DBS or equivalent for working with Adults (minimum of 3 years covering the period of 12 months UK-SBA membership). *
Enhanced Disclosure   Basic Disclosure   No Disclosure – I do not work with vulnerable populations   No Disclosure – non-practicing

Disclosure issue date

My Insurance is current *
Insured by my employer   Insured with Independent Insurance   Not Insured – non-practicing

Insurance expiry date

My Safeguarding Training for Adults is up to date (minimum of 3 years covering the period of 12 month UK-SBA membership) *
Safeguarding Training for Children Completed   Safeguarding Training for Adults Completed   Safeguarding Training for both Children and Adults Completed   No Safeguarding Training – I do not work with vulnerable populations   No Safeguarding Training – non-practicing

Safeguarding issue date

I agree to complete at least 6 CPD during my 12 month membership
Yes   No

I have read and agree to abide by the UK-SBA Code of Ethical and Professional Conduct *
Yes   No

I have read and agree the UK-SBA Complaints Procedure *
Yes   No

I have read and agree to the terms and conditions of the GDPR Policy Documents for UK-SBA Membership *
Yes   No

I understand I will only be contactable via the register if I have opted for and been approved as searchable for work and/or offering supervision.
Yes   No

I confirm I am a resident of the UK and I confirm I am eligible to work in the UK.
Yes   No

I hereby declare that the information I have provided for membership of the UK-SBA is true and correct. I understand that any deliberate dishonesty may result in refusal of this application or termination of membership.
Yes   No

If you have any current unspent sanctions or have been struck off any other register(s)/ relevant bodies then you have a duty to disclose this to the UK-SBA at the time of applying for or renewing membership. If you have any one of these you must tick the relevant statement below. If you respond in the affirmative, your application for membership or renewal will still be considered and you will be invited by the UK-SBA to provide further information. *
I do not have any current unspent sanctions from any employer/other professional register/relevant body. I have not been struck off any other register or relevant body.   I do have a current unspent sanction(s) from an employer/other professional register/relevant body. I have been struck off another register or relevant body.

Approved by PSA Approved by PSA