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Staff Personal Information Form

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Staff Personal Information

Name*
First Middle Last
Email*
Date of Birth*
DD slash MM slash YYYY
National Insurance Number*
Permanent Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Mobile Phone No*
Phone No*
Name of your GP*
Address of GP Surgery*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone number of GP Surgery*
NHS number (if known)*
Name of emergency contact*
Phone number of emergency contact*
Relationship to staff member*
Do you have any medical conditions that might affect your wellbeing during the course?*
Do you have any specific dietary requirements? If so please give details below*
Have you had any recent Safeguarding training?*
If Yes, please give details and dates*
Have you had any recent First Aid Training?*
Do you hold a First Aid qualification?*
If Yes to either of the First Aid questions please give details and dates below*
I give the National Children’s Choir of Great Britain permission to use any still and/or moving image (video, photographs or audio) in which I am depicted during NCCGB activities, for any of the following uses: website, advertising, marketing or any other use such as for training, education or publicity purposes.*
Payment will be made by bank transfer. Please provide details of the account into which you would like payment to be made.
Account Name*
Account Number
Sort Code*
Date*
MM slash DD slash YYYY

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