E-CRB Questionnaire

Please complete the form in BLOCK CAPITALS as fully as possible using black ink and sign. No section should be left blank. If a
question does not apply to you insert Not Applicable. Should you have any queries regarding this form please do not hesitate
to contact Core Connexions Group on 02074070555. The CRB will Cost 55. To complete this form you will need to attach
copies of a valid identity document (i.e. passport) as well as a document verifying your current address (i.e. utility bill or bank
statement).

Title:
MRS
(Please Circle)
Forename:

CORINA

Last Name:

OLARU

Maiden/ Former Name:

POLEC

Date Of name Change:

Date Of Birth:

18/08/2007
11/12/1980

Place Of Birth (Town/Country):

ROMANIA

Nationality:

ROMANIAN

Current Address:

38 HELEGAN CLOSE ORPINGTON KENT BR6 9XH

Date From and To:

Passport Number:

18/11/2011 - 04/10/2012
13682186

Country Passport Issue:

ROMANIA

Passport Issued Date:

22/11/2007

Passport Expired Date:

22/11/2017

Visa Type:

NOT APPLICABLE

Visa number:
NI Number:

NOT APPLICABLE
SK 07 86 57 B

Mobile Number:

07874039282

E-mail:
Position Appling For:

IUB@HOTMAIL.CO.UK
HCA

Do you have any conviction unspent or

spent?

NO

5 Year Address History

Please include full personal address history for the last 6 years including dates. If necessary continue
residency details on a separate sheet and attach to this application.
Address: 38 HELEGAN CLOSE ORINGTON BR6 9XH KENT
__________________________________________________________________________
_________________________________________________________________________________
How long at this address (MM/YY)
From: 18/11/2011
To: 04/10/2012
Address: 01 KNIGHTHEAD POINT THE QUARTERDECK LONDON E14 8SR
___________________________________________________________________________
__________________________________________________________________________________
How long at this address (MM/YY)
From: 04/03/2009
To: 18/11/2011
Address: 14 KNIGHTHEAD POINT THE QUARTERDECK LONDON E14 8SR
___________________________________________________________________________
__________________________________________________________________________________
How long at this address (MM/YY)
From: 01/11/2008
To: 04/03/2009
Address: 105 SCHRIER ROPEWORKS ARBORETUM PLACE BARKING LONDON IG11 7GU
___________________________________________________________________________
__________________________________________________________________________________
How long at this address (MM/YY)
From: 30/10/2007
To: 01/11/2008
Address:14 KNIGHTHEAD POINT THE QUARTERDECK LONDON E14 8SR
___________________________________________________________________________
__________________________________________________________________________________

How long at this address (MM/YY)

From: 10/01/2007
To: 30/10/2007