PART 9: FORMS AND RESOURCES
9.2.2 Worker application form
Confidential
Name of Parish ......
Post applied for ......
Surname ...... Title ......
First Names ......
Home Address ......
...... Postcode ......
Contact Telephone Number ......
Name of church currently attended ......
Name and address of incumbent ......
......
Previous work experience: (Highlight any experience of working with children / young people)
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Why do you want to work with children / young people?
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Have you previously been involved in voluntary work? Yes No
If yes, give details (with dates if possible)
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Do you have any spare time hobbies, interests or activities?
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......
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Any other relevant information? (e.g. any medical conditions or allergies you may have)
......
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Please provide names and addresses of two people whom we could contact for reference (not relatives)
FIRST REFEREEName ......
Address ......
......
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......
Tel ...... / SECOND REFEREE
Name ......
Address ......
......
......
......
Tel ......
Convictions/offences
It is a legal requirement to carry out checks for anyone appointed to a ‘regulated’ position. If successful your appointment will be subject to a satisfactory AccessNI enhanced disclosure.
Under the Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979 convictions which would normally be regarded as ‘spent’ must be disclosed by a person applying to work with children. It is necessary therefore to ask the following questions:
Have you ever been convicted of any criminal offence? Yes No
Are you currently the subject of a police investigation or do you have any prosecutions pending? Yes No
Have you ever been the subject of an investigation alleging that you were the perpetrator of adult or child abuse? Yes No
The Church of Ireland complies with AccessNI Code of Practice. A copy of this is available on request or may be obtained from which has full information on the service including downloadable forms and guidance.
List below details of ALL charges, prosecutions, convictions, cautions, bind-over orders - even if they happened a long time ago. You must include any minor matters, or motoring offences and any which may be pending.
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Please note that disclosure of a conviction does not necessarily debar any applicant from obtaining a position.
Signed (Applicant)
Date ......
FOR PARISH PANEL USE ONLY
WORKER APPLICATION FORM COMPLETE
REFERENCES RECEIVED 1 2
FOLLOWED BY TELEPHONE CALL 1 2
Date application form received ......
INTERVIEW BY PANEL:
1Name: ......
2Name: ......
3Name: ......
Date of interview: ......
RECOMMENDATION: APPROVED / NOT APPROVED / DEFERRED
Main reason for recommendation: ......
......
DISCLOSURE APPLICATION COMPLETED
IDENTITY VERIFIED BY INCUMBENT
DISCLOSURE APPLICATION AND VALIDATION FORM FORWARDED TO
THE BOARD OF EDUCATION NI
DATE SENT ...... DATE RECEIVED BACK ......
UNIQUE REFERENCE NUMBER ......
APPOINTED - No information was received from ACCESS NI to debar appointment
NOT APPOINTED
PART 9 / MAR12 / NI 9.18 – 9.21