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Have you had an Access NI check carried out through either your employment and/or church?Employment Yes No *Church Yes No *
(One of the referees given below should be someone who can confirm that the appropriate checks have been carried out)
Have you ever been convicted of a criminal offence or are you at present the subject of criminal charges? Yes No *If yes, please state below the nature and date(s) of the offence(s)(Please note: the disclosure of an offence may be no bar to your being accepted)
Please provide the names of two referees, one of whom should be your minister / pastor (family members are not acceptable as referees)Name *Address*Phone *Position *Name *Address*Phone *Position *
Do you have any health problems, including disabilities, treatments, allergies etc? Yes No *If yes, please provide us with as much information as you can
Next of Kin:Name *Relationship *Emergency Contact No *