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CYM Core Skills Application Form

This form is for anyone wishing to study any of our Core Skills courses - Explore, Equip: Children's ministry, Equip: Youth work practice or Enable: Schools work

1 Course

2 Personal Details

3 Equality

4 Employment/Experience

5 Authorisation

CYM Core Skills Application Form
This form is to be used for applicants who wish to study for the Explore: Youth work and Peer Leadership, Equip: Children’s Ministry, Equip: Youthwork Practice, Enable: Schoolswork
Which programme of study are you applying for?:
- Equip: Children’s Ministry
- Equip: Youthwork Practice

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Personal details
Address*
Street Address Address Line 2 City County / Region Post Code Country
Name*
First Last
Phone number*
Email*
Date of birth
Date Format: DD slash MM slash YYYY
Country of birth
Country
Nationality
Number of years of Residency (if not born in UK/EU)
Are you currently on prescribed medication?
- No
- Yes
Please give details of your medical condition
Please give the number of days sick taken in the last year

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Equality and Diversity
The following questions are optional but will support our Equality and Diversity recording.
Ethnic Group
Employment Status
Ability Status
Gender
Special educational needs

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Employment history and voluntary work experience
Experience details
Please give full details of work you have undertaken with young people, children, families and/or schools, especially the church(es) and/or agency(ies) you have been working with, nature of the work, time spent in the various types of work and how long you were doing that particular work. Please use an additional sheet of paper if necessary and illustrate how you have fulfilled the “vocational” entry criteria.
Other interests and further information
Please use this section to tell us briefly about yourself and your reasons for wanting to study the course

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Personal declaration
Because of the nature of the course for which you are applying, this application is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means you are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the provisions of the Act. In the event of acceptance, failure to disclose such convictions could lead to disciplinary action being taken and any offers for a place on the course being withdrawn. Any information given will be treated in the strictest confidence and used solely in relation to this application. Please be aware that for positions involving substantial access to young people or children a system of checking police records for possible criminal background will be implemented.
Have you ever been convicted or cautioned with respect to a criminal offence?
- Yes
- No
Please give full details of your criminal conviction or caution
Please give details of a DBS check which has been completed within the last two years in conjunction with your placement-
DBS Enhanced Disclosure Number
Date issued
Date Format: DD slash MM slash YYYY
I confirm that all information given in this application is true, complete and accurate and that no information requested or other material information has been omitted. I agree to my personal data being processed by CYM and where appropriate by a CYM agency.*
- I DO
PLEASE TYPE YOUR NAME HERE THIS WILL BE YOUR SIGNATURE OF AUTHORISATION ON THIS DIGITAL FORM
Date
Date Format: DD slash MM slash YYYY
Data Protection
The Data Protection Act 1998 allows you to ask us for a copy of all the information we have about your application. We charge £10 for this service to cover administrative costs. If at any time you would like a copy of your information, please write to us giving your full name, address, and personal ID, and send us a cheque or postal order for £10, payable to St John’s College

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CYM Core Skills Application Form

CYM Core Skills Application Form

Personal details

Equality and Diversity

Employment history and voluntary work experience

Personal declaration

Please give details of a DBS check which has been completed within the last two years in conjunction with your placement-

Data Protection