Safeguarding Process - Step ONE

Personal Information Form

Name

First Name

Last Name

Maiden name or Previous name

Mobile/Landline

Address

Post Code

How long have you lived at this address/

If less than 12 months, please state your previous address.

Previous Post Code

How long did you live here?

Date of Birth

YYYY

Occupation

How long have you attended Severn Vineyard Bristol?

Which Community Group do you attend?

Please give details of any other churches you have attended in the past 5 years:

Could you please tell us a little bit about your journey of faith with Jesus so far?

In caring for our children/young people/vulnerable adults, we believe it is our responsibility to seek individuals that are able to provide healthy and safe relationships, and appropriate conduct. It is therefore necessary to ask the following questions and the information you provide will be treated as confidential by the church leaders. Have you ever been convicted of a criminal offence (including any "spent convictions" under the Rehabilitation of Offenders Act 1974) or been cautioned by the police or bound over to keep the peace or have any cases pending?

Nature of Offence

Date of Offence

Would you be happy to complete a criminal record disclosure form? (This is required for all children and young people's workers).

Have you ever been held liable by a court for a civil wrong or had an order made against you by a matrimonial or family court?

Has your conduct ever caused or been likely to cause harm to a child or put a child at risk, or, to your knowledge, has it ever been alleged that your conduct has resulted in any of these things?

Do you suffer or have you suffered from any illness which may directly affect your work with children/young people/vulnerable adults?

Which area of children's/youth/vulnerable adults ministry are you interested in?

Please outline any previous experience of looking after or working with children/young people/vulnerable adults. Please include details of any relevant qualifications or appropriate training either in a paid or voluntary capacity.

Are you prepared to undertake appropriate training?

I declare that the above information is accurate and complete to the best of my knowledge. I confirm that I have read, understand and accept Severn Vineyard's Child Protection Document on protecting children/young people. I will agree to carry out the guidelines and follow safe working practices. I have understood the nature of the work I am to do with children/young people/vulnerable adults.

Please type your name below to confirm and today's date:

Reference Details:

Are you happy for us to contact your named referee in order to collect a reference?

Yes

Referee Name, Email Address, Postal Address and Contact Number:

Please note:

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. In the event of an appointment, any failure to disclose such convictions could result in the withdrawal of approval to work with children in the church.

Safeguarding Process - Step ONE

Personal Information Form

Copyright © Severn Vineyard Church Bristol 2023 - All rights reservedWebsite design by Tom Barnard & Mark Garbers

Copyright © Severn Vineyard Church Bristol 2023 - All rights reserved
Website design by Tom Barnard & Mark Garbers