• We will contact you via email and text, if you wish to be contacted by another means please give details below:
  • A Leader in your church who has known you for at least 1 year:

  • I am applying for: (Tick as appropriate)

    Any special general date requests – i.e. last Saturday of the month or alternate Saturday to my street pastor rota etc.
  • You do not have to complete the training before to beginning on the rota.

    These training sessions will be:
    1.Prayer Pastors Training Session
    2.Street Pastors Roles and Responsibilities training Session
    3.Patrol Observation Night

  • I agree that all information I am party to during my role as Prayer Pastor will be treated with confidentiality.

Confidential Self Declaration Form

  • Under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, the persons you will be working with include children and vulnerable adults. This means that you are exempt from the Act and will be asked to declare any previous criminal convictions including ‘spent’ convictions. This information can then be used as a basis for deciding whether or not you are suitable to work with children and vulnerable adults. The disclosure of an offence will not necessarily be a bar to your appointment. However, failure to disclose an offence or other misrepresentations may result in the termination of your services. This form is strictly confidential and, except under compulsion of law, will be seen only by those responsible for your appointment, the Coleraine Street Pastors Child Protection and Vulnerable Adults Officer and his/her deputy. All forms will be kept securely under the terms of the Data Protection Act 1998.

    Please refer to the Guidance Notes when completing this form. If you answer YES to any question, please give details, using a separate sheet if necessary, giving the number of the question you are answering.
  • Please tick either the YES or NO Box in answer to EVERY QUESTION
    If yes, please give details, including the date(s) and nature of the conduct, or alleged conduct, and whether you were dismissed, disciplined, moved to other work or resigned from any paid or voluntary work as a result.
  • Before an appointment can be confirmed, applicants must ensure that they have applied for an Enhanced Disclosure Without Barred List Check from the Disclosure and Barring Service.