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Appendix No. 1A
REPRESENTATION ON COUNTRIES OF RESIDENCE IN THE LAST 20 YEARS
_______________________
(place, date)
_______________________
(first and last name of the job applicant)
____________________________________________
(name of the Employer or another organizer)
Pursuant to Article 21(5) of the Polish Law of 13/05/2016 on Combating Sex Crime and on the Protection of Minors (consolidated text: Journal of Laws of 2023, item 1304, as amended), I represent that in the last 20 years:
I did not reside* in a country other than Poland and my country of citizenship;
I resided in a country other than Poland and my country of citizenship, i.e., in ___________________________________
I represent that I am aware of the criminal liability for making a false statement.
__________________________
(signature of the job applicant)
* Please strike out whichever does not apply.
Appendix No. 2
____________________________ ____________________________
(first and last name) (place, date)
____________________________
(address)
REPRESENTATION ON HAVING NO CRIMINAL RECORD AND REPRESENTATION CONCERNING A COUNTRY OTHER THAN POLAND NOT MAINTAINING A CRIMINAL REGISTER AND NOT ISSUING CERTIFICATES OF NO CRIMINAL RECORD
I represent that the following country (countries):* _________________________________________
does not (do not) maintain a criminal register/does not (do not) issue certificates of no criminal record.
At the same time, I represent that I have not been convicted, in the above country (countries), of a criminal offense corresponding to the criminal offenses specified in Chapters XIX and XXV of the Polish Criminal Code, in Articles 189a and 207 of the Polish Criminal Code, and in the Polish Law of 29 July 2005 on Combating Narcotics Addition, that no ruling has been issued with respect to me stating that I have committed such criminal offenses, and I that am not prohibited, under a ruling of a court or another authority or under statutory regulations, from holding any or specific positions, performing any or specific professions, or carrying out any or specific activities related to upbringing, education, rest, medical treatment, psychological counseling, spiritual development, sport, or other hobbies of Minors or related to exercising care over minors. I am aware of the criminal liability for making a false statement.
____________________________
(legible signature)
* Please specify the country (countries).
Appendix No. 3
PRINCIPLES OF SAFE RELATIONS BETWEEN ANDEA PERSONNEL AND MINORS
The overriding principle for all of the actions taken by the Personnel shall be acting for the good of Minors and in their best interest. The Personnel shall treat Minors with respect, considering their dignity and needs. Any form of violence or abuse towards a Minor is unacceptable. To this end, the members of the Personnel shall act in accordance with the applicable legal regulations, the Employer抯 internal regulations, and their competences. The principles of safe relations between the Personnel and Minors shall apply to all members of the Personnel and to all persons having contacts with Minors if such contacts take place in the Workplace and with the Employer抯 approval. Knowledge and acceptance of these principles shall be confirmed by each of the members of the Personnel.
Relations between the Personnel and Minors
You are required to maintain professional relations with Minors and to consider, in each individual case, whether your reaction, message, or action addressed to a Minor is appropriate to the situation, safe, justified, and fair with respect to other Minors. Act in a way that is overt and transparent to others, so as to minimize the risk of a wrong interpretation of your behaviors.
Communication with Minors
When communicating with Minors, be patient and respectful.
Listen to them attentively and provide answers that are appropriate to their age and the situation.
Do not embarrass, humiliate, disrespect, or insult Minors. Do not shout at Minors, unless this is necessary to ensure the safety of the given Minor or other Minors.
Do not disclose sensitive information concerning a Minor to unauthorized persons, including other Minors. This applies to the image of the Minor and the information about their family and their economic, medical, and legal situation.
When making a decision concerning a Minor, inform them about it and try and take into account their expectations.
Respect the Minors right to privacy. If protecting a Minor means having to ignore the principle of confidentiality, explain it to them as soon as possible.
When working with Minors, try to be within the eyeshot and earshot of other members of the Personnel.
Do not behave in an inappropriate manner in the presence of Minors. This includes the use of vulgar words, gestures, and jokes, making offensive comments, and making use of a relationship of power or physical advantage over a Minor (intimidation, coercion, threats).
Assure Minors that if they do not feel comfortable in the given situation or about a specific behavior or specific words, they can talk about it to you or another person (depending on the intervention procedures in force at the Employer抯) and that they can expect appropriate reaction and/or assistance.
Actions to be taken with respect to Minors
Appreciate and respect the contributions made by Minors, actively engage them, and treat them equally regardless of gender, sexual orientation, disability, social, ethnic, or cultural status, and world view.
Avoid favoritizing Minors.
Do not enter into any sexual or intimate relations with Minors and do not make inappropriate proposals to them. This includes sexual comments, jokes, and gestures as well as making available to Minors erotic and pornographic materials, regardless of their form.
Do not record the image of a Minor (e.g. filming, recording the voice, taking photos) for private purposes. This also includes permitting third parties to record the image of a Minor if the Employer has not been informed about it and has not agreed to it and if consent has not been obtained from the Minor抯 Legal Guardians and the Minor themselves.
Do not offer alcohol, tobacco products, or illegal substances to Minors and do not partake of these products and substances in the presence of Minors when carrying out official duties or staying in the Workplace.
Do not accept money or gifts from Minors or their Legal Guardians. Do not enter into any relations of dependence with a Minor or a Minor抯 Legal Guardians that could lead to accusations of unequal treatment or obtaining financial and other gains.
Physical contacts with Minors
All forms of violence or abuse towards Minors are unacceptable. However, there are situations where physical contact with a Minor is acceptable and in compliance with the principles of safe contact梬hen it is a response to the Minor抯 need in the given moment and considers the Minor抯 age, stage of development, and gender as well as the cultural and situational context. Still, it is impossible to define which forms of physical contact are universally acceptable since a behavior that is appropriate in the case of one Minor may be inappropriate in the case of another Minor. Always exercise professional judgment, listen, observe, and take note of the Minor抯 reaction; ask the Minor for permission to engage in physical contact (e.g. hugging) and remember that even if your intentions are good, they may be misinterpreted by the Minor or third parties. In particular:
do not hit, prod, shove, or otherwise violate the physical integrity of a Minor;
never touch a Minor in a way that could be seen as indecent or inappropriate;
always be ready to explain your actions;
be especially careful with Minors who have suffered violence or abuse or have been harmed, including sexually, physically, or through neglect. Experiences like that may sometimes cause a Minor to look to establish indecent or inappropriate physical relations with adults. In such a case always act tactfully, but firmly and help the Minor understand the meaning of personal boundaries;
physical contact with a Minor should never be covert or related to any reward and should never stem from a relation of power. If you witness any of the above behaviors and/or situations from other adults or Minors, always report this to the responsible person and/or act in accordance with the applicable intervention procedure.
Contacts outside of working hours
In principle, you should only contact Minors during working hours and for purposes within the framework of your duties.
Protecting Minors
If you work with a Minor who has been harmed, including sexually, physically or through neglect, be careful and keep your distance in order to protect the Minor. Always explain the boundaries of a relation to a Minor.
If a case of harming is suspected or disclosed, always allow the Minor to speak out, present their standpoint/opinion, bearing in mind that for the Minor, this could be the first and only conversation on this topic (the Minor might never attempt to look for support again). It is particularly important to:
assure the Minor that they were right to speak about the harm done to them;
explain to the Minor that they are not guilty of what has happened;
be clearly negative about any form of violence or abuse, sending a clear message that you believe this is unacceptable and should be prevented/stopped;
inform the Minor that other, competent people will handle this matter and that actions will be taken to make sure that the Minor is safe.
Appendix No. 4
PRINCIPLES OF IMPLEMENTING THE PROCEDURE OF RESPONDING
TO DIFFICULT OR AGGRESSIVE BEHAVIOR OR VIOLENCE ON THE PART OF A MINOR
If a Minor is observed to display excessive tension, irritation, or difficulties suggesting a probability of occurrence of a difficult behavior, including aggression, self-aggression, or a behavior posing a threat to the Minor or their surroundings, actions should be immediately taken in order to prevent the occurrence of such a behavior, including by starting a calming conversation, if possible, on a neutral topic (the method of shifting attention) or engaging in another calming activity.
If difficult or unwanted behaviors escalate, an attempt should be made to extinguish or interrupt them, depending on the situation.
If the actions taken in the given situation do not produce results and an escalation of difficult, aggressive, or self-aggressive behaviors follows, the person appointed to carry out an intervention or other members of the Personnel located nearby should be informed, asking for assistance; these persons shall immediately notify decision-makers or specialist and provide assistance.
In the event of a highly aggressive behavior that cannot be stopped and that poses a threat to the life and health of the Minor and other persons, first aid should be immediately provided if necessary, an ambulance and/or the Police should be called, and then the Minor抯 Legal Guardians should be notified梚n such a case, if this is necessary, possible, and safe for every person involved in the incident, the least invasive form of interrupting the act of aggression may be used.
The safety of each of the persons involved in the incident, including witnesses, should be ensured.
If circumstances allow, the person specified in the intervention procedure shall immediately start a conversation allowing the Minor to express themselves and present their standpoint/opinion in order to determine the reasons and the circumstances of the incident; during the talk with the Minor, all of the important information should be noted down, unless this would disrupt the talk; after the conversation, a memo shall be produced with respect to the incident and the information provided by witnesses; the situation shall be reported to the Coordinators.
Until it is certain that the situation has been defused and the difficult behavior has stopped, the Minor shall not be left alone.
The safety of all of the persons involved in the incident, including witnesses, should be ensured and they should be provided with assistance, e.g. psychological/pedagogical counseling. If the Employer has no capabilities in this respect, he may refer these persons to the entities listed in section 4.1.3.
Special conditions for intervention conversations
The conversation should not take place under the pressure of time, the Minor should not be rushed, and the talk should be adapted to the needs and capabilities of the Minor; the Minor抯 language and forms of communication should be taken into account.
During the conversation, the Minor should be allowed to speak freely, including if they want to disclose their fears; the Minor should not be interrupted or criticized; their statements should not be supplemented with your own speculations; you should not comment on the information provided by the Minor and should not minimize the importance of what has happened.
The conversation should take place in a calm atmosphere; after it is concluded, the Minor should receive appropriate support until the situation has been stabilized and the Minor has calmed down. The Minor cannot be left alone until it becomes certain that the situation has been stabilized.
Appendix No. 5
INTERVENTION SHEET
1. First and last name of the Minor2. Reason for intervention (type of harm)3. Person reporting suspected harm4. Description of actions taken
DateAction
5. Meetings with the Minor抯 Legal Guardians
Date Description of the meeting
6. Form of intervention used
(please circle the relevant option)Notification of suspected criminal offense
Request for examining the situation of the Minor/family
Another form of intervention. Please specify:7. Details of the intervention
(name of the authority to which the intervention has been reported) and date of the intervention
8. Outcome of the intervention:
Actions of law enforcement authorities, if information on outcomes/actions of parents was providedDateAction
Appendix No. 6
WHERE TO REFER A LEGAL GUARDIAN LOOKING FOR SUPPORT FOR THEMSELVES AND THE MINOR
Local Social Welfare Centers in addition to economic, legal, housing, material, and other support, many of these Centers offer workshops that help improve skills in terms of raising children, courses on parental competences, and Parents Academy classes. Moreover, Social Welfare Centers offer assistance provided by family assistants (at the request of parents) and the option to apply for a personal assistant to be appointed for a disabled person if the family takes care of a child holding a certificate of disability. For many families, the possibility of having the support of an assistant is what saves the child and the family from a lasting crisis. Social Welfare Centers provide their services free of charge.
Crisis Intervention Centers these are run by district authorities. They offer assistance to persons who have found themselves in a difficult situation or lost their mental balance due to e.g. the death of a close one, their own illness, the illness of their child or close one, divorce/separation, family conflicts, or a threat of violence/abuse. The Centers also provide psychological counseling, carry out crisis interventions, and organize short-term therapy, workshops, and support groups. Crisis Intervention Centers provide their services free of charge.
Psychological/Pedagogical Counseling Centers these provide diagnostic assistance and counseling, organize psychoeducational courses and courses that improve parental skills (e.g. schools for parents, positive discipline workshops, workshops for parents of ADHD-diagnosed children). They hire certification teams, which allows for obtaining a certificate confirming the need for special education, early development support, or an individual curriculum. Psychological/Pedagogical Counseling Centers provide their services free of charge.
Specialist Family Counseling Centers public centers providing psychological assistance and support to couples and families. They organize counseling sessions for individuals and families and organize psychotherapy for children and adults as well as workshops and groups for adults. Specialist Family Counseling Centers provide their services free of charge.
Early Intervention Centers these offer comprehensive, coordinated, and multi-dimensional specialist assistance to children aged under 7 and their Legal Guardians (in terms of taking care of the child). Early Intervention Centers function within the framework of the National Health Fund; a referral from a physician is required. At an Early Intervention Center, a child can be provided with early development support therapy, physical therapy, speech therapy, and other forms of assistance. Early Intervention Centers provide their services, which are daytime services, free of charge.
Daytime Support Centers (formerly: Day-Care Centers) a child抯 stay at the Center may last for several hours (mainly after school), is free of charge and voluntary, and the offer is addressed primarily to families that have problems with raising and caring for their school-age children. At a Daytime Support Center, a child can have a meal, find someone to help them with their homework, take part in social therapy and compensation classes, etc.
Mental Health Centers for Adults and Mental Health Centers for Children and the Youth these offer support to children and parents in a mental crisis or having parental problems (individual assistance, therapy groups, and workshops). The Centers function within the framework of the National Health Fund.
Children Assistance Centers institutions where children who are victims of criminal offenses and their Legal Guardians receive comprehensive and interdisciplinary assistance. This means that the case of a child who comes to the Center is managed, from the beginning to the end, by the same group of professionals. At the meetings of an interdisciplinary team, they make decisions together on what type of support the child and its Legal Guardians need. The assistance strategy is carried out, to the extent possible, by school employees: psychologists, physicians, welfare specialists. The Center is also the place where a court hearing of a child takes place, if one is required. A map of the Centers is available at HYPERLINK "http://centrapomocydzieciom.fdds.pl/" http://centrapomocydzieciom.fdds.pl/.
National and local NGOs that support parents and children. Parents should be encouraged to check and look for an offer that suits their needs. The available options include support groups (for parents of small children, for grieving parents, for parents of children with disabilities, etc.), counseling and psychological therapy, workshops and psychoeducational classes for parents, workshops f o r c h i l d r e n .
T r u s t P h o n e L i n e f o r c h i l d r e n a n d t h e y o u t h ( 1 1 6 1 1 1 ) o p e r a t e d b y t h e D a j e m y D z i e c i o m S i B F o u n d a t i o n f r e e o f c h a r g e , a n o n y m o u s , a v a i l a b l e 2 4 / 7 i n P o l i s h , U k r a i n i a n , a n d R u s s i a n l a n g u a g e s ; h t t p s : / / 1 1 6 1 1 1 . p l
C h i l d r e n s T r u s t P h o n e L i n e o r ganized by the Children抯 Ombudsman (800121212) free of charge, anonymous, available 24/7 in Polish, Ukrainian, and Russian languages, HYPERLINK "http://800121212.pl" http://800121212.pl
Appendix No. 7
SPECIMEN OF AN INTERVENTION LETTER
1. Specimen of a notification of a potential criminal offense
_______________________
(place, date)
Regional Prosecution Office in Krak體
Reporting person: _____________________________________
(full name and address of the Employer)
represented by: ________________________________
correspondence address: ______________________________
NOTIFICATION OF A POTENTIAL CRIMINAL OFFENSE
I hereby notify a potential criminal offense consisting in ____________________, perpetrated to
(please describe)
the detriment of the minor ________________________________________
(first and last name, date of birth)
by ___________________________________________________________________________
(first and last name of the alleged perpetrator)
JUSTIFICATION
While ______________________________________ was carrying out official duties
(first and last name of the member of the Personnel)
with the minor ______________________________, the minor disclosed worrying information
(first and last name)
concerning
________________________________________________________________________________ (description of the situation)
Considering the above and the well-being and safety of the minor, please initiate proceedings in this case. More information is available from:
________________________________________________________________________________
(first and last name, contact details)
Please send any and all correspondence to the registered address of the company.
_______________________________
(signature of the person responsible for interventions)
Appendix No. 8
STANDARDS FOR THE PROTECTION OF MINORS SHORT VERSION FOR MINORS
Andea Group抯 Standards for the Protection of Minors are a document that has been developed in order to ensure that you, Minors, are treated with dignity and respect and protected from harm.
We especially want you to feel safe and comfortable at Andea.
The document is divided into several parts:
Identifying a situation where harm is being done to a Minor
All of the members of the Personnel must react if you or another Minor is being harmed.
There are various forms of doing harm, including:
physical violence, including pushing, hitting, pinching, kicking, and throwing objects at someone;
emotional abuse, including insulting, ridiculing, calling names, making fun of;
sexual abuse, including forcing someone to watch naked people, making photos or recording videos of Minors with no clothes on, forcing someone to touch the private areas of other people;
neglect, i.e., failure to satisfy the physical and emotional needs of a Minor, including failure to provide food, proper clothing or cosmetics, failure to send a child to school, and failure to take a child to the doctor.
If you have experienced any of the above forms of harm from an adult or another Minor, tell a member of our Personnel about it. According to the type of situation, the relevant procedure will be initiated.
Selection of Personnel members
We verify whether your Vocational/Pupil Internship Coordinator has previously engaged in violence or abuse. For that purpose, every job applicant is screened in this respect against the relevant register; this person is also required to provide the relevant documents confirming that they have never engaged in violence or abuse.
Taking actions
Always let a member of our Personnel know if something makes you worried or if you are not feeling safe梬e will take actions, carrying out an intervention. An intervention will also be carried out if we notice that something is dangerous for you.
We can also call the Police to support us; sometimes we fill out special documents and send them to the relevant authorities.
Principles of safe relations
For your comfort, we have written down several principles we will comply with:
the overriding principle for all of the actions taken by each of the members of our Personnel is acting for your good and in your best interest;
we treat you with respect, considering your dignity, needs, and right to privacy;
any form of violence or abuse towards you is unacceptable;
entering into any sexual or intimate relations with you is unacceptable;
recording your image (e.g. filming, recording the voice, taking photos) for the private purposes of a member of our Personnel is unacceptable;
every form of contact between a member of our Personnel and you must be overt and a result of carrying out official tasks and duties;
it is unacceptable to maintain contacts where a member of our Personnel gives you money or presents or uses their advantage, power, or your dependence in order to satisfy their own needs;
our Personnel makes sure that every message, action, or activity addressed to you is appropriate to the situation, your level of development, and your mental and physical capabilities, as well as safe, justified, and not resulting in unequal treatment of you versus other Minors, including in the form of favoritizing.
The members of the Personnel are also required to pay special attention to inappropriate behaviors among Minors.
These behaviors include in particular:
all forms of violence or abuse;
bullying, in particular when using vulgar and offensive language;
shaming, humiliation, disdain;
recording of image (taking photos or recording videos) without the Minor抯 consent, especially in a situation that may cause embarrassment or insult;
comments intended to be offensive, intimidating, coercive, or threatening;
actions that violate the right to privacy.
Safe use of the Internet and electronic devices
The Employer provides you with access to the Internet on a device owned by him, making sure that you are secured against access to content that can be a threat to your proper development.
At the Workplace, during a break, you have the right to use a mobiles phones and other electronic devices with your own access to the Internet, provided that the use of these devices does not interrupt the work of other persons around you.
If other members of the Personnel notice that you play dangerous content on your private device, this will be reported to the Vocational/Pupil Internship Coordinator in order to implement preventive measures.
Nobody is allowed to record you without your consent; you should not record anyone without their consent, either.
evalsuation of the Standards for the Protection of Minors
We review this document at least once every two years. If we notice the need for changes, we must implement them.
Publishing the Standards for the Protection of Minors and making them available
The Standards for the Protection of Minors come into effect on February 26th, 2025 and remain in force until repealed.
We have made Andea Group抯 Standards for the Protection of Minors available in the Guidelines & Policies folder that can be accessed by all members of our Personnel and on the HYPERLINK "/" www.ynsun.net website.
Appendix No. 9
REPRESENTATION OF A MINOR AND THEIR PARENTS/LEGAL GUARDIANS ON HAVING READ AND UNDERSTOOD THE STANDARDS FOR THE PROTECTION OF MINORS
I, the undersigned, represent that I have read and understood the documentation comprising the Standards for the Protection of Minors in force at the Andea Group.
_____________________________
(date, signature of the Minor)
_____________________________
(date, signature of a Legal Guardian)
Appendix No. 10
REPRESENTATION ON HAVING READ AND UNDERSTOOD AND UNDERTAKING TO COMPLY WITH THE STANDARDS FOR THE PROTECTION OF MINORS IN FORCE AT THE ANDEA GROUP
I, the undersigned __________________________________________________, represent that
(first and last name of the member of the Personnel)
I have read and understood the Standards for the Protection of Minors in force at the Andea Group and undertake to comply with them.
__________________________________
(signature of the person making the representation)
Appendix No. 11
ANDEA GROUP扴 REGISTER OF INTERVENTIONS#First and last name of the MinorDate and place Reporting personType of harm, person doing the harm or suspected of harming the MinorProcedures and forms of providing assistance to the Minor usedPersons, institutions, and external authorities notifiedType of documentation produced during the intervention (official memos/intervention sheets/conclusions, etc.)
All content copyright 2025 Andea Sp. z o.o. All Rights Reserved.
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