THE NATIONAL ASSOCIATION OF SECURITY DOG USERS
INDIVIDUAL MEMBERSHIP APPLICATION FORM
CONTACT DETAILS
Title: Mr/Mrs/Miss Other:……………………………...Date of Birth:……../……../……..
Surname: ………………………………………………...... First Names: ……………………………….……………
Previous Surnames (Changed by marriage, deed Poll, Etc.)………………………………………………....……..
Home Address:……………………………………………………………………………………………………......
…………………………………………………………….....Post Code: …………………………………………………..
Tel No.:……………………………………...... Mobile: ……………………………………………………….
E-mail: ……………………………………………………...Fax: …………………………………………………………...
EMPLOYMENT
Do you work in the security industry? YES / NOJob Title: …………………………………………………….
Do you hold an S.I.A. Licence?YES / NOFront Line YES / NONon Front LineYES / NO
Sector:Security Officer □Door Supervisor □CP □ Other □ …………………………………….
Licence No: …………………………………………………Date of Issue: ……../……../……..
Have you ever been prosecuted for a criminal offence or have you any prosecutions pending?YES / NO
Have you ever been investigated/prosecuted for any animal welfare issues?YES / NO
If yes to either please give full details on a separate sheet.
How did you hear about NASDU?
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Why do you wish to become a member of N.A.S.D.U.?
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Have you ever had any experience of handling dogs? If yes please state in what capacity.
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Do you hold any professional Certificates related to working with dogs? If yes please list and enclose copies.
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FEBRUARY 2009
ARMED SERVICE / PUBLIC SERVICE EMPLOYMENT (If Applicable)
Sector
Police□Military □Prison Service□Customs □Other □ …………………………………
Employer: ……………………………………………………………………………………………………………………….
Regiment/Section/Department: …………………………………………………………………………………………
Employment Dates:From: ………./...... /……….To: ………./………./……….
Reason for Leaving (if applicable): ………………………………………………………………………………………
Rank or Position: ……………………………………………………………………………………………………………
PERSONAL REFEREES: Please give details of two people, other than family, who have known you long enough to form an accurate assessment of you (must have known you for a minimum of 2 years within the past five years).
1. Name: …………………………………………...... 2. Name: ……………………………………………………..
Address:…………………………………………...... Address: ……………………………………………………..
……………………………………………………...... ……………………………………………………………......
Post Code:………………………………………...... Post Code:………………………………………………......
E-mail: …………………………………………………….E-mail: ……………………………………………………….
Profession:………………………………………...... Profession:…………………………………………......
How long known?………………………………...... How long known?………………………………….…......
PLEASE ENTER ANY FURTHER INFORMATION BELOW WHICH YOU FEEL WOULD ASSIST YOUR MEMBERSHIP APPLICATION WITH NASDU
AGREEMENT
I certify that the particulars given by me in this application are correct to the best of my knowledge and belief and I agree to act in a professional manner at all times and where applicable abide by such Codes of Practice and conduct which may be in place
Signature: ………………………………....………………Date: ……../……../……..
PROOF OF IDENTIFICATION
Please enclose a copy of photo ID – i.e. SIA licence, driving licence, passport etc.
PLEASE ENCLOSE A CHEQUE OR POSTAL ORDER MADE PAYABLE TO N.A.S.D.U. FOR £25.00
FOR OFFICIAL USE
Membership Received By:……………………………… Date:………/……../……..
Form of Payment:……………………………………….. Received By:………………………………......
Application Approved By:………………………………Date: ……../……../……..
Membership Details Sent By:…………………………Date: ……../……../……..
FEBRUARY 2009