Addiction Professionals Membership Application for ADFAM Drug and Alcohol Family Worker Applicants

All applicants must answer each of the questions below. Please note that deliberately false statements will result in non acceptance / cancellation of your membership. If you answer ’yes’ to any questions below please provide additional information. Please note that answering yes to questions in the declaration does not mean you will not be accepted for membership.

Do you have a conviction which is not spent under the Rehabilitation of Offenders Act 1974 in the UK, or a conviction in another country which might prejudice the public’s trust in you, your profession or AP if accurately informed about the details? (required)

NoYes

Have you ever been found guilty of a civil offence (with the exception of parking or speeding offences)? (required)

NoYes

Have you ever been refused/ expelled from membership of any other professional body/ register on the grounds of professional misconduct or other professional related offence? (required)

NoYes

Have you ever been the subject of any professionally related disciplinary action? (required)

NoYes

Are you currently / likely to be the subject of any criminal, civil, investigatory or disciplinary proceedings or enquiries? (required)

NoYes

Have you ever been, or are you likely to be involved in a situation or incident likely to result in disciplinary action against you as a member of AP? (required)

NoYes