Application form

Application form - Slough Baptist Church

For those wishing to work with children, young people or vulnerable adults
Full Name *

First Name Last Name
Birth Date

Month Day Year
Who will you be working with? *

Children/Youth Adults at risk
Address

Street Address

Street Address Line 2

Town/City

Post Code
Previous addresses (last 5 years) including post codes
Phone Number (landline)
Phone Number (mobile)
E-mail *
Previous churches (last 5 years)
References
Please give the names and contact details of two people who know you well and would be able to give you a personal reference. These can be people from the church but not members of your own family.
Reference 1 - name *

First Name Last Name
Phone Number
E-mail *
Reference 2 - name *

First Name Last Name
Phone Number
E-mail *
Declaration
We ask you to sign the following declaration to indicate that you understand it is a great responsibility to work with children and young people and recognise the need to ensure their safety.
Have you ever been convicted of a criminal offence, been charged with a criminal offence or been subject to a criminal investigation, or are you currently subject to an investigation ? *

Yes No
If yes, please give details of any offences against children, young people or vulnerable adults or any offence including sexual activities or violence. Please also state details of any drugs related offences.
(including dates)
Have there ever been any allegations made against you by children, young people or vulnerable adults alleging sexual or violent misconduct? *

Yes No
If yes, please give details
You may be asked to provide further details, but having a criminal conviction on its own (apart from convictions of abuse against a minor) will not disqualify you from working with young people as a volunteer.
Because of the nature of the work for which you are applying, this position is exempt from the provision of section 4 (ii) of the Rehabilitation of Offenders Act 1974 (Exceptions Order 1975), and you are therefore not entitled to withhold information about convictions which for other purposes are "spent" under the provisions of the 1974 Act and in the event of appointment, any failure to disclose such convictions could result in the withdrawal of approval to work with children, young people or vulnerable adults within the church.
In submitting this form you confirm that you have read and understood the Slough Baptist Church Guidelines for Children’s and Youth Workers and that this means co-operating in obtaining a Disclosure and Barring Service (DBS) check
Date

Day Month Year
Should be Empty:

Application form - Slough Baptist Church

References

Declaration