Chaperone application form

Personal information
Name of organisation associated with (if applicable):
Title:
First name
Last name
Any other names known by (i.e. maiden name):
Date and place of birth
Date of birth:
Place of birth:
Address
Address Line 1:
Address Line 2:
Town/City:
County:
Postcode:
How long have you lived at your current address for?
If less than 5 years please list previous address(es):
Contact details
Telephone Number:
Mobile Number:
Email:

Chaperone history
Have you ever been approved as a Chaperone/Matron? If so, when and by which Authority? If Trafford please provide a reference number:
Are/were you a registered child minder or foster carer? If so, when and with which Authority?
Have you received first aid training?
YesNo
Do you hold a valid driving license?
YesNo
Would your car insurance allow you to carry passengers whilst you are employed as a chaperone?
YesNo
Are you Registered Disabled?
YesNo
If you answered yes to the above question please provide your reference number.
Do you have any health condition that might have a bearing on your application? If so, give details:
Upload
Have you undertaken Child Protection training in the last three years? If so, provide copy of certificate or details of provider and dates, for verification purposes.
Upload
The Authority is entitled, under arrangements introduced for the protection of children, to check with the Criminal Records Bureau for the existence and content of any criminal record. Therefore, you will be required to complete a disclosure form to enable an enhanced check to be undertaken.
The work for which you are applying will entail regular contact with children and is exempt from the Rehabilitation of Offenders Act 1974. Therefore, you are required to declare any convictions, cautions, bind-overs or prosecutions you may have, even if they would otherwise be regarded as 'spent' under this Act.
If either you have a DBS check already in place (issued within the last 3 months) or you are on the DBS update system, or you are a Trafford council employee and hold an enhanced children’s workforce DBS certificate please enter your DBS reference number below. If you don't have a check in place leave the answer blank and then purchase a DBS check through the child employment homepage on the Trafford Council website using your reference number for this application. If you have applied through the website please enter your DBS payment reference number:
If YES, please specify the date of conviction, Court, nature of offence and sentence imposed.
You are also required to declare any cautions, bind-overs or prosecutions you may have, even if they would otherwise be regarded as “spent” under the above Act. Please enter details below: