Form 1:

Form 1:

Request to initiate a DBS application
Full Name*

First Name(s)Last Name
Date of birth*
Postal address*

addresspostcode
Email Address*
example@example.com
Contact Number

Area CodePhone Number
Name of the church *

church name and town town /village
Church denomination?*
I wish to complete my DBS application:*

option A - ONLINEoption B - USING A PAPER DBS FORM
My role will involve working directly with:*

children /young peoplevulnerable adultsno direct work with children or vulnerable adults
Your role/ job title*
If your role / job title is not included in the list above or if you do more than one role please add details below
Please give a brief outline of your direct work with children or vulnerable adults (If trustees do not do direct work they should note the children's /vulnerable groups activity in the church)*
Role with ADULTS will involve ( tick all that apply):*

transporting a vulnerable adult for health or social care (e.g.. to doctors / hospitalcollecting an adult from a residential hometrustee in a church that has specific activities for children and /or vulnerable adultsassisting a vulnerable adult with shopping, bills or personal affairsPersonal care - assisting with feeding, dressing or hygieneI do not work directly with vulnerable adults/ adults at riskI regularly help with teaching, guiding or advising adults or give care, supervisionI regularly provide transport to adults on behalf of the church (other than for health care purposes e.e. to church services/activities)
How frequently do you carry out your role with adults?*

DailyWeeklyMonthlyOccasionallyno direct work
Roles with CHILDREN (tick all that apply):*

I do not work directly with childrenI transport a child/ childrenI work with children in my own homeI work unsupervised with childrenI lead an activity (unsupervised)I supervise other children's workersPersonal care (prompting or helping young, ill or disabled children with eating/ washing/ toileting nappy changingI will be working with children and will always be supervisedtrustee in a church that has specific activities for children and /or vulnerable adults
How frequently do you carry out your role with children?*

DailyWeeklyMonthlyoccasionallyno direct children's work
Will you be under constant supervision when working with children?*

YesNo
Is this DBS check for a

new role/postholderan existing postholdera renewal for an existing postholder
Is this DBS check for a*

voluntary positionpaid position
All applicants will need to meet with a verifier to show 3 identity documents. Please note the name of your local verifier (if known).
I have read the Panel Privacy Statement DBS ( https://panel.cymru/en/dbs) explaining how my information will be collected and used by the Panel and DBS*

Yes
Thank you for completing this information form. Please note: this Jotform 1 is NOT your DBS application form. You will soon receive an email from noreply@employmentcheck.org.uk with a link and a password to enable you to complete your online DBS form. Please complete this promptly.
Should be Empty: