First Names
Surname
Home Address
Postcode
tel
mobile
email
work/term address
Postcode
tel
email
dates at this address	from to
Male Female
Date of Birth	Age
Nationality
Are you engaged to be married? yes no
(to be completed by non British applicants only) My Passport details
Passport Number
Date of Issue
Expiry Date
Tick if you presently hold no Passport
My UK Visa details
Type of Visa
Date of issue
Expiry date
Tick if you presently hold no UK Visa

1. Name of Secondary School / 6th Form College
Main exams passed
Date of leaving
2. Name of College/University
Course
Date you graduate or complete course
Date of leaving
3. Present job
Date started
Length of notice expected
4. Do you have further training/study or career in mind? If so what?

1. Give the name of your home church and, if different, the one where you regularly worship (e.g. when at college)

Name of Home church
Name of Minister/Vicar/Leader
Address
Postcode
Tel
email
Dates attended	from to
Name of Other church
Name of Minister/Vicar/Leader
Address
Postcode
Tel
email
Dates attended	from to

2. How are you involved in the life of this/these fellowships?

3. What other Christian activities (camps/houseparties/work teams etc) have you been or are you planning to be involved in?

What responsibilities have you had?

4. Have you had any training in any Christian activity or service?

5. What experience have you had – voluntary or paid - of working with children, young people or vulnerable adults?

1. What musical gifts/qualifications do you have? If so, how have you used them?

2. What active involvement do you have in sports or hobbies?

3. Do you have drama/creative gifts? If so how have you used them?

4. Do you have any other practical skills/training/interests?

5. Transport

Do you hold a driver’s licence? 

yes no

provisional full

Do you/will you have the use of a:

Car yes no   motorbike yes no

1. Are there any significant illnesses or injuries for which you have attended a doctor or been in hospital within the last 5 years

yes no

2. Have you suffered from any mental illness or psychological problem for which you have sought advice?

yes no

3. Have you ever suffered from anorexia nervosa or bulimia nervosa?

yes no

4. Have you ever had glandular fever or suffered from M.E.?

yes no

5. Do you have any strong dietary likes/dislikes or any major allergies? 

yes no

6. Are you presently receiving any specific healthcare or using any prescribed medicines?

yes no

7. Do you have any other special need requiring particular care? 

yes no

8. How much sick leave have you had in the last 3 years (with reasons)?

9. Please give the name and address of your GP/doctor and tick below if you are willing for the Careforce Health Advisor to approach him/her for further medical information (we will only do this if absolutely necessary):

GP/Doctor's name:
address:
	I confirm that Careforce may contact my doctor to obtain further medical information

1. How did you hear about Careforce?

2. What kind of voluntary service would you prefer if available?

3. State any geographical preferences you have

4. Please indicate if you are also applying to other organisations for voluntary service

1. Have you ever been charged with or convicted of a criminal offence; or are you at present the subject of criminal investigations? (NB the disclosure of an offence may be no bar to your appointment).

Please type yes or no

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

Please type yes or no

If yes please give details:

* Because of the nature of the work of Careforce this position 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.

I, confirm that the information given in this document is true to the best of my knowledge.

Date: (tick box to confirm)

1. Spiritual referee

Name
address
postcode
tel
email

2. Spiritual referee

Name
address
postcode
tel
email

3. Academic/professional referee

Name
address
postcode
tel
email

1. Please say briefly how you became a Christian

2. How do you seek to keep your relationship with God fresh and relevant?

3. Why are you offering for service through Careforce?

4. What do you believe to be the essentials:

a. about God the Father

b. about God the Son

c. about God the Holy Spirit

d. about the Bible

5. Describe how someone or something (e.g. a book, film, event) has challenged you recently

6. Please add anything else you think relevant to your application

The End