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YOUR CHURCH

APPLICATION FORM FOR VOLUNTARY WORKERS WITH CHILDREN AND YOUNG PEOPLE

The Church Council is responsible for the appointment of all workers with children and young people. Every worker should fill in a copy of this form, which should be retained by the secretary of the church council.

Full Name ...............................................

Maiden or Former Name ......................................

Home Address ........................................

................................

Telephone day.....................evening..............

date of Birth ................................

How long have you lived at the above address? ................

If less than 12 months please give the following information:

Previous Address ...........................................

...........................................

How long there? ......................

Name of church attended ...................................

...................................

Name of minister .........................................

Please give details of previous experience of looking after or working with children and/or young people, including details of training received. (use the reverse side if necessary)

Reference please give the name, address, telephone number and position or relationship of someone who knows you.

Declaration. (see note below *)

Have you ever been convicted of a criminal offence, or are you at present the subject of criminal charges?

Yes/No

(N.B. The disclosure of an offence may be no bar to your appointment)

Nature of Offence

Date of Offence ......................

Signed ............................... Date ..................

* Because of the nature of the work for which you are applying, this post is exempt from the provision of Section 4 (ii) of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975, and you are therefore not entitled to withhold information about convictions which for other purposes are 'spent' under the provisions of the Act and in the event of appointment, any failure to disclose such convictions could result in the withdrawal of approval to work with children and/or young people within the church.

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