Staff Form

Guildford City Swimming Club Staff Form

Please can all new members of staff complete the following form with as much detail as possible.

    Applicant Details


    First Name

    Middle Name

    Last Name

    Date of Birth



    Post Code

    Your Email (required)

    Please note that the Club uses email to communicate with its staff and an up to date email address is essential.

    Home Phone No


    Emergency Phone No (required)

    A further contact number of a person we can contact in an emergency is essential.

    Parent / Guardian Details

    Staff under 18 must supply parent/guardian details below.
    (Please note if the applicant is also 16 or under and will be 16 or under in June of the current school year we must apply for a licence from the relevant County Council in which the applicant goes to school. This may also mean that the applicant is restricted in the hours and days they are able to work.)

    Please note that as we are employing the applicant all contact with the Club relating to their employment can only be to and from the applicant and not via the parent/guardian. We are however happy to copy emails to parent/guardians. The applicant must have their own email account that they monitor regularly.

    Parent / Guardian Name

    Relationship to Applicant

    Address (if different from above)

    Your Email

    Contact Phone No (if different from above)

    Is a county council form needed?

    Medical Details

    To be completed by all members of staff.

    Please select Yes or No as appropriate and complete further details as necessary.

    Do you have any specific medical conditions requiring medical treatment and / or medication that are likely to affect your/their work?
    If yes, please give details

    Any other relevant information?
    If yes, please give details

    Applicant’s Qualifications

    Please complete the following:

    ASA Qualified Coach YesNo
    If ‘Yes’ please state the level

    ASA Qualified Teacher YesNo
    If ‘Yes’ please state the level

    STA Qualified Teacher YesNo
    If ‘Yes’ please state the level

    and expiry date

    Applicant’s Certificates

    Please complete all the following that apply.
    I currently hold a:

    Safeguarding & Protecting Certificate YesNo
    If ‘Yes’ please state who this was issued through

    and the expiry date

    NPLQ Certificate YesNo
    If ‘Yes’ please state the expiry date

    Water Safety Certificate YesNo
    If ‘Yes’ please state who this was issued through

    and the expiry date

    I understand that in order to keep the NPLQ/Water Safety Certificate current I must undertake 2 hours of up date training every month.
    I will undertake this training at

    On the following days and times

    DBS certificates can only be accepted if they were issued by the A.S.A.
    DBS Certificate YesNo
    If ‘Yes’ please state:-
    DBS Certificate No.
    Who this was issued through

    The expiry date

    My IOS Insurance No. is


    Members of staff must supply details of 2 referees.

    Referee 1

    Contact Details 1

    Referee 2

    Contact Details 2

    Club Constitution and Conditions of Staff Membership

    As a member of staff of Guildford City Swimming Club:

    you accept all the terms stated in this form and in the following documents:
    The Club Constitution, and other policy documents, all of which are available on the Club Website under Documentation.
    You supply up to date contact details as requested to the Membership Team (the Club uses email to disseminate information).

    In compliance with the Data Protection Act 1998, all efforts will be made to ensure that this information is accurate, kept up to date and secure and that it is used only in connection with the purpose and activities of the club. Information will not be kept once a person is no longer member of staff. The information will be disclosed only to those members of the club for whom it is appropriate and relevant officers of the Amateur Swimming Association or British Swimming.

    I understand that by submitting this form it will be assumed that all the information I have entered is accurate to the best of knowledge.

    Signed (Member of Staff)


    For Parents / Guardians of members of staff under 18 years

    Signature of Parent / Guardian (if member of staff is under 18 years)

    It may be essential at some time for the Club to have the necessary authority to obtain any urgent treatment which may be required whilst working at Guildford City Swimming Club.
    Would you therefore please complete the details on this form and sign below to give your consent.

    I, being the parent / carer of the above named child hereby give permission for the club to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my son / daughter’s interest, on the doctors medical opinion, for any delay to be incurred by seeking my personal consent.

    Signature of Consent by Parent / Carer

    Print Full Name


    Please prove you are human