Student

Community

Patrolapplication form

Surname / First name
Date of Birth / Student ID / s
Course / Expected year of graduation
Nationality / Mobile
Email you use for Facebook* / Alternative tel. number
Home address
(inc. postcode) / Uni address
(inc. postcode)

*The SCP scheme is co-ordinated through a private Facebook group

Have you ever been any of the following: (tick to confirm)

Freshers’ Volunteer / Ambassador
Residential Assistant / Internal Uni Project Volunteer

Disability

The Equality Act 2010 prohibits discrimination, victimisation or harassment in employment & volunteering, including recruitment.

We welcome the recruitment of people who have disabilities.

Do you have a disability that you wish us to know about at this stage,

including any learning difficulty e.g. dyslexia? YES / NO

If yes, in support of your application please let us know if you believe there are any reasonable adjustments we should be making toenable you to become a Student Community Patroller: ______

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Criminal History

Have you ever been convicted of a criminal offence or received a caution (including reprimand or final warning)? YES / NO

If yes, provide details of the offence, the date of the conviction, the sentence you received and rehabilitation period.Should you be successful in this application, acceptance on the Student Community Patrol scheme will be subject to a satisfactory DBS criminal background check.

______

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Skills and Experience

What relevant experience & skills do you have?(max 150 words please):

______

______

______

______

______

______

______

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Skills and Experience

Why do you wish to join this scheme? (max 150 words please):

______

______

______

______

______

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______

References

Please give names and addresses of two professional referees who you have known for at least a year, such as an employer or tutor. Personal references will not be accepted.

Referee 1 name / Referee 2 name
Email / Email
Telephone / Telephone
Relationship to you / Relationship to you

Clothing size (circle): XS S M L XL XXL

S = up to size 10 women’s / up to chest size 34” men’s

M = up to size 14 women’s / up to chest size 36” men’s

L = up to size 16/18 women’s / up to chest size 40” men’s

XL = 18/20 women’s / up to chest size 44” men’s

Declaration

I declare that I am available in office hours for the5-day Student Community Patrol training programme, which is to be held on 3rd -7thSeptember ’18 inclusive and that if I pass this training, I agree to commit at least four hours per month in term time to thisscheme until the end of the summer term of mygraduation year. I understand that I will be asked to repay the training & uniform costs should I withdraw from the scheme without valid reason or fail to patrol when I am scheduled (rotas are planned well in advance, with volunteer sign off).

I declare that all the statements I have made in thisapplication are true to the best of my knowledge andbelief and that no relevant information has been withheld. I understand that there will be a selection process for this scheme, including an informal interview and the uptake of references.

Signed: ______

Date:______

Thank you for applying to be aStudent Community Patroller.

Return completed forms to any SU office or to

Office use - date form returned:

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