Application

Emergency contacts
Please give contact details for your next of kin and the person we should contact in case of an emergency.
Next of kin name*
Relationship*
Address*
Telephone number
Mobile number
Local emergency contact name (if different)
Relationship
Address
Telephone number
Mobile number

References
Please give details of two people who will provide a reference for you if required. These people must have known you for at least two years. We cannot accept references from relatives or partners. All applicants for volunteering as part of a Duke of Edinburgh award scheme must provide the details of their DofE Co-ordinator.
Reference One - Name
Reference One - Position
Reference One - Address
Reference One - Postcode
Reference One - Telephone number
Reference One - Email
Reference One - Permission to contact?
- Yes
- No
Reference Two - Name
Reference Two - Position
Reference Two - Address
Reference Two - Postcode
Reference Two - Telephone number
Reference Two - Email
Reference Two - Permission to contact?
- Yes
- No

Declarations
I understand that, if successful, the details of this form will be kept on file which I may have access to at any time. I have no objection to these records being kept.*
- I understand that, if successful, the details of this form will be kept on file which I may have access to at any time. I have no objection to these records being kept.
I acknowledge any appointment may be subject to satisfactory references and DBS checks.*
- I acknowledge any appointment may be subject to satisfactory references and DBS checks.
I declare the information given on this form is correct and understand that, if appointed, any misleading statements or deliberate omissions may result in the termination of my position.*
- I declare the information given on this form is correct and understand that, if appointed, any misleading statements or deliberate omissions may result in the termination of my position.
Should you be successful in obtaining this post certain information given on this form will be used to provide your computerised personal record and under the terms of the DATA PROTECTION ACT 2018 will be held securely and treated as being in confidence.
Name
This field is for validation purposes and should be left unchanged.

Trustee