LREG1 - Leader Registration Form - The Boys' Brigade

4TO BE COMPLETEDReferees BY APPLICANT 6 Church NominationTO BE COMPLETEDBY CHURCHPlease supply the name, address, telephone number and positionor relationship of two people to whom reference can be made insupport of your application. Referees should NOT be related to theapplicant.Referee 1Full NamePosition / RelationshipChurch nameWe consider the applicant to be suitable for appointment as aLeader in The Boys' Brigade. This nomination is granted by theGoverning Body of the Church (as above).References were:Taken up & Retained by ChurchNOT taken up (please give reasons)Please state reasons for not checking references:AddressTelephoneReferee 2Full NamePosition / RelationshipAddressTelephonePlease note: References should be retained by the Church5Company NominationSigned (by Company Captain)TO BE COMPLETED BYCOMPANY CAPTAINI consider the applicant to be suitable for appointment as a Leaderin The Boys' Brigade.Helpers and Residential Activity Helpers should NOT be given anyresponsibility for children and young people unless they have completed aChild Protection and Safety Module. After training, they may be givenresponsibility for young people at the Captain’s discretion.Warrant Officers are required to complete Youth Leader Training (or KGVI)by 31st August of the first complete session after registration.Lieutenants/Captains are required to complete Youth Leader Training (orKGVI) before appointment. In addition Captains must have completedCaptain’s Training prior to appointment.I confirm that the relevant training requirements have been met,and give details below (This box MUST be completed forappointments as a Lieutenant/Captain):Provide details of course attended, date and venue:Please note: References should be retained by the ChurchDisclosure checks for applicants are MANDATORY for all thoseworking with children and young people.ENGLAND & WALES AND NORTHERN IRELANDPlease tick ONE box as applicable:A Disclosure check (DBS/AccessNI) has been received(within 6 months), and indicated there is nothing thatwould deem the applicant unsuitable to work withchildren and young people.Disclosure Date of Issue: D D M M Y YMUST BE COMPLETEDDisclosure Number:MUST BE COMPLETEDA Disclosure application (DBS/AccessNI) has been madeand we are awaiting a response. As soon as a response isreceived, BB Headquarters will be informed accordingly.Date Disclosureapplication applied for:MUST BE COMPLETEDName of agencyundertaking the check:MUST BE COMPLETEDD D M M Y YAlready a member of the DBS Update ServiceDisclosure Date of Issue: D D M M Y YMUST BE COMPLETEDDisclosure Number:MUST BE COMPLETEDNo Disclosure application (DBS/AccessNI) has been made,BB Headquarters are requested to carryout a check.SCOTLANDPlease tick ONE box as applicable:The applicant is already a member of the PVG scheme.PVG Scheme Number:MUST BE COMPLETEDThe applicant has applied to become a member of thePVG Scheme.The applicant has previously had a disclosure checkundertaken by the Church.Date Disclosure issued:MUST BE COMPLETEDDisclosure number:MUST BE COMPLETEDD D M M Y YSigned (by Minister or appropriate Church official)Print Name:Print Name:DateD D M M Y YPositionDateD D M M Y YLREG1 - Sept 2013