Fillable Application for Approval as a Chaperone Information for (Rochdale Metropolitan Borough Council)

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Application for Approval as a Chaperone Information for (Rochdale Metropolitan Borough Council)

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1
Application for Approval as a Chaperone
Information for Applicants
Thankyou for the interest you have shown in working as an approved Chaperone in Entertainment. This
information is provided to assist you in completing the application. If you have any questions or queries
in relation to the completion of this form or the procedure for applying for a Chaperone Licence, please
contact the Education Welfare Service. The number can be found on the application form.
This is a role which will bring you into close contact with children and because of this we must make
every effort to check on the suitability, character and criminal background of all applicants. As you will
appreciate, you will need to complete the enclosed forms:
Application form for Approval as a Chaperone
Social Services (Personal Details form)
Rehabilitation of Offenders Act 1974 form
Rehabilitation of Offenders Act 1974
The nature of the role for which you are applying means that you are exempt from Section 4(2) of the
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are therefore not entitled to withhold
provision of theAct and, in the event of you being granted a Chaperone Licence, any failure to disclose
such information could result in the immediate withdrawal of the licence.
Disclose and Barring Service (DBS), previously known as a CRB
Approval as a Chaperone will be subject to an enhanced DBS certificate, this is processed through
Rochdale Borough Council HR Team and costs £44 per application (or £16.80 for a volunteer DBS).
Your email address is essential as the DBS is processed online.
Social Services Personal Details Form
The Department for Health Guidelines recommend that the Local Authority check with Social Services on
the background of certain persons who will have access to children. Please complete Section 1 of this
form to enable this check to be completed.
Photographs
You are required to provide two recent identical passport type photographs with your application.
Interview
On receipt of your completed application form, you will be invited to attend an interview.
2
APPLICATION FOR APPROVAL AS A CHAPERONE
The Children (Performances) Regulations 1968
This form should be completed in Block Capitals in black ink
PERSONAL DETAILS
Title
(Mr, Ms, Mrs, Miss other)
Surname
First Name
Date of Birth
National Insurance Number
Email address
Address:
Postcode
Home Tel
Number
Mobile Tel Number
APPLICATION DETAILS
Are you applying to be a volunteer or professional chaperone?
Have you ever been approved as a Chaperone in either this Local Authority or others?
If yes, please state details below:
Local Authority
Dates: From: To:
Have you ever been approved as a registered Child Minder or
Foster Carer?
Yes / No
If yes which Social Services Department gave approval
Have you had any relevant experience of working with children
(apart from your own) in either a professional or voluntary
capacity?
Yes / No
If yes, please provide details of your current post or if not currently working with children, your last post involveing
working with children (including dates). You should provide the name and address of a referee for this post in the
Reference Section of this form:
If you drive a car, does your car insurance allow you to carry passengers whilst your are employed as a
Chaperone? Yes / No
(you may need to check with your insurance provider and a copy of your insurance certificate will need to be
provided)
Are your registered disabled? Yes / No
Do you have any health conditions that may have a bearing on your application? Yes / No
If yes please give details:
Do you have Qualified Teacher Status (QTS)? Yes / No
3
REFERENCES
Please provide the names, addresses and occupation or relationship of two referees. References will not be
accepted from relatives or people writing solely in the capacity of a friend. If you have experience of working with
children (either paid or unpaid), you must provide a referee from that period of work.
Referee One
Name:
Occupation / Relationship
Email address:
Address:
Postcode
Home Tel Number
Mobile Tel Number
Referee Two
Name:
Occupation / Relationship
Email address:
Address:
Postcode
Home Tel Number
Mobile Tel Number
DISCLOSURE AND BARRING SERVICE (DBS)
Applicants will be asked to apply for an enhanced DBS if they have not had one issued in the last 6 months.
Further information about the Barring and Disclosure Scheme can be found at www.disclosure.gov.uk
FAIR PROCESSING NOTICE AND EXTERNAL REGISTER
Should your application be approved, you will be issued with a certificate of approval and an identity card. Your
personal details (name, address and contact information etc) will be added to the Rochdale MBC database of
approved Chaperones which is maintained and held by the Education Welfare Service. These details are not
shared with anyone outside of Rochdale Borough Council other than to confirm your identity as an approved
licenced Chaperone.
When your application is approved you may approach any organisation (Theatre, Film/TV Production Company,
Modelling or Casting Agency) who may require approved Chaperones and give them your personal details and
offer your services. These organisations may then contact Rochdale Borough Council to verify that you are an
approved Chaperone. We will confirm only the fact that you are an approved Chaperone and the expiry date of
your licence. No other personal details will be given to these people or organisations.
However, Rochdale Borough Council is occasionally approached by such organisations to supply them with the
names and contact details of Rochdale approved Chaperones. This is in order that they can then contact the
Chaperones to offer short-term employment looking after children taking part in performances or modelling. In
anticipation of these requests, a separate list is held of all the Chaperones who have given their consent to
Rochdale Borough Council to release their contact details to these organisations.
Any Chaperone contacted this way is free to negotiate the terms of employment or to decide whether or not to take
up the offer. These are matters for the Chaperone and the “Employer” and will not involve Rochdale Borough
Council.
Should your application be successful, do you want your personal details to be kept on this separate list and
released to such organisations on request.
Yes / No ________________________ (Signed).
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4
DECLARATIONS
Failure to provide true and accurate information may lead to disqualification and the immediate withdrawal of the
Chaperone Licence.
1. Have you ever been the subject of any Child Protection concern, either in your work or personal life, or
disciplinary action, including any which time is expired? Yes / No
2. I have read and understood all the questions on the application form.
3. I am not subject to any immigration controls or restrictions which prohibit my undertaking work in the UK.
4. I understand that:
I. Under the Rehabilitation of Offenders Act 1974, if successful, I will be asked to sign a written
declaration stating any cautions, bind-overs, prosecutions or convictions which are either on my record
or pending, even if they would be regarded as ‘spent’ under the Act. I understand that, if successful, I
may be questioned about the content of the declaration. I further understand that failure to disclose
such convictions may result in the immediate withdrawal of the licence.
II. Under Home Office guidelines regarding the protection of children, I will be asked to agree to a check
being made by the Criminal Records Bureau about the existence and content of a criminal record.
III. In accordance with the Data Protection Act, the personal details submitted with this application form
will be used only for selection and interview procedures and for employment records if successful.
IV. Providing false information is an offence and could result in my application being rejected or withdrawal
of the Chaperone Licence and possible referral to the police.
5. The information I have given on this form is true and accurate to the best of my knowledge.
6. If my application for approval as a Chaperone is successful, I agree to notify Rochdale Borough Council
within seven days of:
i. Any arrest for any offence, or conviction of any offence (excluding fixed penalty fines) in a court of law
whether in the United Kingdom or elsewhere.
ii. Any notifiable illness
iii. Any health condition or debility that may affect my ability to carry out the duties of a Chaperone
iv. Any change of name or address.
SIGNED ___________________________________ DATE: ________________________
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5
Social Services Personal Details Form
NOTE TO THE APPLICANT
Current Department of Health Guidelines recommend that the Local Authority check with Social Services on the
background of certain persons who will have access to children. In order for this check to be done please complete
section 1.
SECTION 1: FOR COMPLETION BY THE APPLICANT
Surname
First Name
Date of Birth
Place of Birth
Previous / Other Names or aliases
(eg Maiden Name)
Address:
Postcode
Home Tel
Number
Mobile Tel Number
Provide details of any previous addresses used in the last 5 years (including postcodes)
From: To:
From: To:
Continue overleaf if necessary
In connection with the application, I will have substantial access to children and agree to enquiries being made in
confidence from Social Services (this information is to be used for the above purpose only).
Signed: ____________________________ Date: _____________________________
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6
Rehabilitation of Offenders Act 1974
The nature of the work for which you are applying means that you are exempt from Section 4 (2) of the
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are not, therefore entitled to withhold
information about any cautions or convictions which for other purposes are ‘spent’ under the provisions of the Act
and, in the event of a Chaperone Licence being issued, any failure to disclose such information could result in the
immediate withdrawal of the licence.
If you are successful in your application, the information on this form will be considered and if you declare any
previous charges or criminal convictions, they may be discussed with you prior to the Chaperone Licence being
issued. Please be aware that the Local Authority has a policy on recruitment or ex-offenders and that a criminal
record will not automatically debar anyone from employment with the Council. You should also be aware that your
referees will be informed that they can disclose any charge or conviction they consider relevant.
DECLARATIONS
Have you ever been:
Cautioned of any offence? Yes / No
Convicted of any offence? Yes / No
If you have answered Yes to any of the above questions, please give brief details of the offence(s) with dates:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
In either event, you must sign and date the form in the space below:
Signed: ____________________________ Date: _____________________________
Name (Please Print) ____________________________________________________________
ROCHDALE BOROUGH COUNCIL IS COMMITTED TO THE SAFEGUARDING AND PROMOTING THE WELFARE OF
CHILDREN AND YOUNG PEOPLE AND EXPECTS ALL STAFF AND VOLUNTEERS TO SHARE THIS COMMITMENT
SUBMISSION OF APPLICATION
Once you have completed the form in full, it should be returned to:
Education Welfare Team
Rochdale Borough Council
Number One Riverside
Smith Street
Rochdale OL16 1XU
Should you have any enquiries, require further information or wish to make arrangements to submit the application
you can do so by using the following contact details:
Telephone: (01706) 925115 or email education.welfare@rochdale.gov.uk
Find out how we use your personal information at http://www.rochdale.gov.uk/privacy
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Application for Approval as a Chaperone Information for (Rochdale Metropolitan Borough Council)

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Completed 10 December 2020

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