Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Home address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any medical or special needs that we should be aware of? *

Yes

No

Have you ever had an offer of work with children/young people declined? *

Yes

No

Have you completed a DBS enhanced disclosure in the last 3 years? *

Yes

No

Date

MM

DD

YYYY

Have you attended a Safeguarding training course in the last 3 years? *

Yes

No

Date

MM

DD

YYYY

Under the Protection of Children Act 1999 and the Criminal Justice and Court Services Act 2000 it is an offence for any organisation to offer employment that involves regular contact with young people under the age of 18 to anyone who has been convicted of certain offences. Because a position with Souster Youth potentially involves substantial, unsupervised contact with children and young people, it is exempt from the provision of section 4(ii) of the Rehabilitation of Offenders Act 1974 (Exemptions Order 1975). You are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act; in the event of appointment, any failure to disclose such convictions could result in the withdrawal of approval to work with children and young people in Souster Youth activities. An offer to volunteer with us will be subject to obtaining an Enhanced Disclosure from the Disclosure and Barring Service (DBS). This process is subject to a strict code to ensure confidentiality, fair practice and the security of information disclosed. We emphasise that a criminal record will not necessarily be a bar to working with us, only if the nature of any matters revealed could be considered to place children or young people at risk. I confirm that the information provided on this form is correct *

Yes

No

I am willing to complete a DBS check *

Yes

No