HOCKEY IRELAND Affiliated to the International Hockey Federation and to the European Hockey Federation
Previous Garda Vetting This form is only to be used where an individual has been previously Garda Vetted through Hockey Ireland within the last 5 years. It must be accompanied by a batch header from your club/branch. PLEASE WRITE LEGIBLY.
Forename and middle name: Surname: Date of birth: Current address: Telephone & email: Specific Role applied for: Club/Branch:
Self-Declaration Do you agree to abide by the guidelines contained in the Hockey Ireland Code of Ethics? Yes No Do you agree to abide by the rules of the organisation (Hockey Ireland/Branch/Club etc.)? Yes No Have you ever been asked to leave a sporting organisation? Yes No Is there any reason you would be considered unsuitable to work with children or vulnerable persons? Yes No (If you have answered yes to the two questions above, provide details and we will contact you in confidence) ______Have you ever been convicted of a criminal offence or been the subject of a caution; been Bound Over; or are you at present the subject of criminal investigations? Yes No (If you have answered yes, provide details below and you will be contacted in confidence) ______
I agree to inform the Designated Person of my organisation should I be subjected to any criminal proceedings or statutory investigation that may bring the organisation into disrepute or put children or vulnerable persons at risk. I authorise Hockey Ireland to check its records for a statement as to any convictions recorded against me in the Republic of Ireland or elsewhere, successful or not, pending or completed, in the State or elsewhere, arising from my previous Garda Vetting application.
Signature ______
Date ______
Office & Administration: Newstead Building C, UCD, Belfield, Dublin 4 Tel: +353 1 7163262 Email: [email protected] Website: www.hockey.ie