Please complete all relevant sections- deleting/ticking where appropiate.

All information will be treated in the strictest confidence.

Personal details

Name (in full):

Marital status:Date of birth:

Full Postal Address:Postal Code:

Date moved into that address

(As this information is requiered for the police check please be specific)

Tel.No: HomeWork

Email

I am applying for (tick all that apply)

After Shool Clubs: Holiday Clubs:

Before School Clubs:

EDUCATIONAL BACKGROUND

In completing this section please also include all relevant years/dates.

School (s) Attended Qualifications Gained

Further Education

Qualifications/ Certificates

EMPLOYMENT HISTORY

Present Position

Position Held:

Full-time: Part-Time:

Employer's Name and Address:

Previous Appointments

Please list these in reverse date order - most recent fisrt:

Position Held Employer's name From To

Any relevant courses (e.g. current first aid certificate)

REFEREES

Please supply the names and addresses of at least two people who could provide appropiate written references or act as valid referees stating their position and/or relationship to you:

Personal Declaration

I declare that all the above information is true and accurate and I understand that you will need to have an official police check undertaken - as this is now compulsory requirement for anyone who is working with children.

Name Date