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Child Protection Policy

Child Protection Policy Index

Community Pages

Personal Profile Form

To be completed by all new volunteers/employees.

1. Organisationís Name: ___________________________________________________

2. Personal Details

Title: ______ Forename: ____________________ Surname: ____________________

Date of Birth: ____________ Telephone No (incl STD code): _________________________

Address: ______________________________________________________________

________________________________________________
Postcode: ____________

Occupation: _________________________________
Currently Employed: YES / NO

3. Qualifications/Training - Please enter details of any qualifications or training courses you have attended which are relevant to caring for young children.

Date(s) Title of Qualification/Training Subjects Studied Length of Course Name of Organisation

4. Experience - Please give details of experience of working with under 16ís.
 and young people under the age of 16?
Where previously have you worked with In what capacity?

Between which dates?

Other comments:

5. Referees - Please provide the names and addresses of TWO responsible persons for reference purposes. Referees should not be related to you and, where possible, should have a knowledge of your ability to care for or be in the proximity of children. All references will be taken up. You should secure prior agreement of referees before providing their names.

Referee 1

Name: ______________________________________

Address: ____________________________________

_______________________________________________

_______________________ Postcode: _____________

Referee 2

Name: ______________________________________

Address: ____________________________________

______________________________________________

_______________________ Postcode: _____________

6. Declaration - I have read and understood the organisationís Child Protection Policy and agree to CONFIDENTIAL vetting procedures. I agree to inform the organisation of any change in circumstances.

Signed: _____________________________________________
Date: ______________

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