Position(s) applied for:*Full Name:*Maiden/Former Name(s):*We will need to see a birth/marriage certificate or document regarding each change of name.Date and Place of Birth:*Please give town and country of birth.Current Phone Number*Please give the best number to reach you on for any questions about this application.Current Email Address:* Current Address:* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country If you are a student or living at a temporary address, give your current "permanent" address... we will need to match the address given here with your Drivers' Licence if you have one, and any other Identification you provide for the DBS check.Have you lived at this address for*5 years or more?Less than 5 years?Current Address:* Street Address Address Line 2 City County / State / Region ZIP / Postal Code If you are a student or living at a temporary address, give your current "permanent" address... we will need to match the address given here with your Drivers' Licence if you have one, and any other Identification you provide for the DBS check.Have you lived at these two addresses for*5 years or more?Less than 5 years?Current Address:* Street Address Address Line 2 City County / State / Region ZIP / Postal Code If you are a student or living at a temporary address, give your current "permanent" address... we will need to match the address given here with your Drivers' Licence if you have one, and any other Identification you provide for the DBS check.Please tell us about your Christian experience/experience in the church(es)/organisation(s) you have been involved in:*Please include names, dates and detail of the areas of your involvement. Type None if this will be your first experience.How long have you been at King's Church High Wycombe?*If you are at another church, other than King's, please give the church name and the length of time there.Please give details of previous experience of looking after or working with children and young people or vulnerable adults:*This should include details of any relevant qualifications or appropriate training either in a paid or voluntary capacity. Type None if this will be your first experience.Are you currently working in any other care position in either a voluntary or paid capacity?*Name of the Organisation; Contact Person; Contact Phone or Email; Details of Duties. (Type No if not applicable.)Have you ever had an offer to work with children, young people or vulnerable adults declined?*NoYesPlease give details...*Are there any ways that we can support you in your work with children, young people or vulnerable adults?*NoYesAnswering ‘yes’ to this question does not mean you will not be considered for this post. We are committed to meeting the requirements of the Disability Discrimination Act 1995 and 2004, and all other similar legislationPlease give details...*Past and Current Employment History*Employer's Name; Employed from and to dates; Job Title and Description; Reason for Leaving. (Enter None if you have not yet been employed)ReferencesPlease complete the details below of two people who would be willing to provide a personal reference. • If you are currently working, (paid or voluntary) one of these should be your present employer, • Your other referees should not be family members and must have known you for more than 2 years. * We reserve the right to take up character references from any other individuals deemed necessary.Referee # 1 - Name*Full Name, and Job Title if applicable.Referee # 1 - Phone Number*Ideally a mobile, to which we will text a link to an online form.Referee # 1 - Email Address*We will send them a link to an online form.Referee # 2 - Name*Full Name, and Job Title if applicable.Referee # 2 - Phone Number*Ideally a mobile, to which we will text a link to an online form.Referee # 2 - Email Address*We will send them a link to an online form.Church Leader - Name*This could be a Small Group or Serving Team Leader at King's if you've been at King's Church for more than 6 months. If you are new to King's Church or attend another church, please give the name of the Church Leader at your previous/current church AND the name of the church.Church Leader - Contact DetailsIf they are at King's Church then you can leave this blank. If they are at another Church, please tell us the best way to contact them if that needs to be done.I confirm that the submitted information is correct and complete, I understand and agree to the conditions involving a Disclosure check.* YesData ProtectionWe are required by our Safeguarding Policy to ask all prospective workers with children, young people and adults to complete this form. The information will be kept confidentially by the place of worship/organisation, unless requested by an appropriate authority.
