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Position applied for:

Residential Centre Manager
Residential Activity Coordinator
Residential Activity Monitor
Non-Residential Activity Monitor

Preferred centre:

Do you have accommodation here?

(Centre Manager and Activity Coordinator applicants tick 'yes')

YES
NO

Exact dates available (Most courses will require

you to be available from the beginning of July):

Personal Details

Title:

First name:

Surname:

Date of Birth:

Nationality:

Home address:

Tel:

Mobile:

E mail:

Current address (if different from above):

Tel:

Do you have the use of a car?

YES
NO

Please give details of any illness or disability which may affect your ability to work:

Do you have a criminal record?

YES
NO

If YES, please give details:

(People who may be required to work with children and young people are not covered by the Rehabilitation of Offenders Act 1974, and can be required to declare all criminal convictions, spent or otherwise)

First degree or equivalent

A-Level, GNVQ, GCSE Qualifications

SKILLS (Give details of any skills which may be relevant to student activities, e.g. sports, drama, first aid, life saving etc.)

FOREIGN LANGUAGES (Please indicate either conversational or fluent)

All references will be followed up. References will include a specific enquiry as to whether there is any impediment to the prospective staff member being employed in a situation where he/she will have responsibility for the care of or substantial access to children. Appropriate Criminal Records Bureau (CRB) disclosure may be requested prior to appointment. Give the name, address, phone/fax/email and relationship to you of two referees we can contact. One should be your last employer. Referees must not be family relations or friends.

Referee 1


Referee 2

Where did you hear about LSC/STS?:

YES
NO

YES
NO

YES
NO

YES
NO

YES
NO

 
If you have answered ‘yes’ to any of the above questions, please supply the dates and circumstances:

By submitting this application I certify that the information contained in this application is correct, and that I am not unfit to be working with juniors.

Section 70(a) of the Children Act 1989 provides that a person who makes any statement in this notice or gives information which he/she knows to be false or misleading, shall be guilty of an offence and liable on summary conviction to a fine not exceeding level 5.

Consent: I agree to the local authority arranging for police records to be checked for previous convictions of me, the staff member, subject to the Rehabilitation of Offenders Act 1974 and exemption orders.