Apply for a chaperone licence

Name

First name

Last name
Date of Birth
Telephone number
Mobile number
Email
Address
Postcode
Have you ever been employed previously as a chaperone in either this local authority or others?
If yes, please state the name of the authority, the period of time you were a chaperone with this authority including dates, and any other details. If this is not applicable to you, please put N/A in the text box.
Please tell us about any relevant experience you have of working with children in either a voluntary or professional capacity.
Name and address of organisation / dance school. If this is not applicable to you please put N/A in the text box.

Your attention is drawn to the fact that under the Rehabilitation of Offenders Act 1974 you may be entitled to answer “no” to this question even if you have, in the past, been subject to criminal proceedings resulting in conviction(s). However, certain types of employment are excluded under the Rehabilitation of Offenders Act 1974 (Exemptions) order 1957, from the protection of the Act. It is, therefore, suggested that you take appropriate advice if you are in any doubt as to the correct answer to give.
Have you ever been convicted of a criminal offence?
If yes, please specify date of conviction, Court, nature of offence and sentence imposed.

Declaration
I declare that to the best of my knowledge the information I have provided is correct. I give permission for this to be used to carry out checks against any records held with Wigan Council Children’s and Families teams and other local authorities for the purpose of establishing my suitability for a license. I understand that the authority will need to make further enquiries regarding any possible convictions I may have. I also give consent for the information I have provided to be shared with the organisation I have named for the purpose of verifying my identity and role. I also consent to Wigan Council sharing my contact details (email and telephone number) when companies request details of professional chaperones licensed by the Council for the purpose of them contacting me about potential employment. I acknowledge that any license issued will also be shared with the organisation named and the performance venue to satisfy them I have the appropriate license.
I agree

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