ASA Educator Licence Application / Renewal- Tutor/Assessor
Personal Details
Full Name
Address
Postcode
Telephone Contact Details
Email Address
ASA Educator Number (if
known)
IoS Membership Number (if
applicable)
Qualifications trained to Deliver
Educator Licence Requirements- Tutor/Assessor (please see booklet for more detailed information)
Please
the appropriate box to confirm that the required evidence has been submitted
1.
Passport Photo (initial licence application ONLY)
2.
3.
Relevant aquatic qualification for each course to be delivered (Initial licence
Application ONLY).
Teaching Qualification Certificate (initial licence application ONLY).
4.
Assessing Qualification Certificate (initial licence application ONLY).
5.
DBS Enhanced Disclosure (every three years if not on the update service)
6.
Safeguarding Training (every three years)
7.
Public or Civil Liability Insurance Certificate (every year)
8.
9.
10.
11.
12.
Agree to abide by the Code of Ethics and licence terms and conditions
(every year)
Delivery and assessment of a minimum of one ASA qualification – at
highest level (every year)
If delivering and assessing multiple disciplines evidence of delivery and
assessment is needed at the highest level for all disciplines (within the last
three years)
Relevant Continual Professional Development (every year)
Licence Fee of £25
Please ensure that if you are posting original documents that you send them via recorded delivery. Please note that the ASA is not
responsible for any items lost in the postal system. Original items will be returned to you by recorded delivery.
Please complete and return this form, together with the required evidence to: ASA Workforce Support Services, SportPark, 3
Oakwood Drive, Loughborough, Leicestershire, LE11 3QF or via email workforcesupport@swimming.org
Licence applications received after the renewal date (1st April 2016) will still be processed, however the licence period will not change
and the licence will expire on the 31st March 2017. A fee of £10 will be charged for any licence that has to be ‘fast-tracked’ through the
process. This will apply to any application that is received less than 10 working days prior to a course start date.
ASA Code of Ethics and ASA Child Safeguarding Policy and Procedures (Every Year)
I acknowledge that I am aware of the ASA Code of Ethics and Child Safeguarding Policy
and Procedures and that I have read and understood these documents.
I understand that any contravention by me of any of the provisions of the ASA Code of
Ethics or ASA Child Safeguarding Policy and Procedures may give rise to a complaint
being made against me under the ASA Judicial Laws and/or may give rise to the
suspension or withdrawal of any certificates that I may have been awarded by the ASA.
Yes, I understand
Terms and Conditions
I acknowledge that I am aware of the ASA Educator Licensing terms and conditions within the
licensing booklet on page 12 and that I have read and understood them.
Yes, I understand
Data Protection
The ASA/British Swimming would like to share the following information (associated with your
Workforce Licence) within the organisation:
1. Your contact details
2. Your current licence position i.e. current, pending, lapsed
3. Courses which you are approved to deliver/assess
For data protection legislation we need your permission to do so, so please indicate below which
statement applies to you.
I give permission for the ASA/British Swimming to share the above
details within the organisation
I do not give permission for the ASA/British Swimming to share the
above details within the organisation
No thank you, I do not want British Swimming / the ASA to send me
details of products and services
No thank you, I do not want British Swimming / the ASA to send me
details of events
No thank you, I do not want British Swimming / the ASA to send me
details from British Swimming / the ASA’s commercial partners
Signature
Date
Please ensure that if you are posting original documents that you send them via recorded delivery. Please note that the ASA is not
responsible for any items lost in the postal system. Original items will be returned to you by recorded delivery.
Please complete and return this form, together with the required evidence to: ASA Workforce Support Services, SportPark, 3
Oakwood Drive, Loughborough, Leicestershire, LE11 3QF or via email workforcesupport@swimming.org
Licence applications received after the renewal date (1st April 2016) will still be processed, however the licence period will not change
and the licence will expire on the 31st March 2017. A fee of £10 will be charged for any licence that has to be ‘fast-tracked’ through the
process. This will apply to any application that is received less than 10 working days prior to a course start date.
ASA Equal Opportunity & Diversity Form
The ASA is committed to promoting equal opportunities and diversity in employment, in respect of our
recruitment and selection procedures and in ensuring that all employees receive equal treatment in
employment.
We seek to employ a workforce which reflects the diverse nature of our community and value the
contribution of each individual regardless of sex, age, marital status, disability, sexual orientation,
race, colour, religion, ethnic or national origin.
Responses will be treated in the strictest of confidence. The information you provide will be used for
statistical analysis only and will assist in evaluating the Company’s progress towards improvements in
its diversity strategy. We would, therefore, be grateful if you would complete the details below in line
with our commitment to promoting diversity.
The information will be held in compliance with the Data Protection principles as set out in the Data
Protection Act 1998. Should you become an employee, we will seek periodic confirmation from you as
to its accuracy.
(Please tick the appropriate boxes)
Name:
Date of Birth:
Gender:
Male
Female
White
British
Irish Gypsy or Irish Traveller
Other
Please specify:
Black/African/Caribbean/Black British
African
Caribbean
Other
Please specify:
Asian/Asian British
Indian
Pakistani
Bangladeshi
Chinese
Other
Please specify:
Mixed/multiple ethnic groups
White and Black Caribbean
White and Black African
White and Asian
Other
Please specify:
Other ethnic group
Arab
Other
Please specify:
Prefer not to say
Please ensure that if you are posting original documents that you send them via recorded delivery. Please note that the ASA is not
responsible for any items lost in the postal system. Original items will be returned to you by recorded delivery.
Please complete and return this form, together with the required evidence to: ASA Workforce Support Services, SportPark, 3
Oakwood Drive, Loughborough, Leicestershire, LE11 3QF or via email workforcesupport@swimming.org
Licence applications received after the renewal date (1st April 2016) will still be processed, however the licence period will not change
and the licence will expire on the 31st March 2017. A fee of £10 will be charged for any licence that has to be ‘fast-tracked’ through the
process. This will apply to any application that is received less than 10 working days prior to a course start date.
Ethnicity:
Religion or Belief:
No Religion
Buddhist
Jewish
Sikh
Prefer not to say
Sexual Orientation
Straight/Heterosexual
Bisexual
Prefer not to say
Christian
Hindu
Muslim
Other
Gay/Lesbian
Other
Disability:
Learning Difficulty:
No Disability
Visual Impairment
Hearing impairment
Disability affecting mobility
Other physical disability
Other medical condition-e.g. diabetes,
epilepsy, asthma, etc
Emotional/behavioural difficulties
No Learning Difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Other specific learning
difficulty
Autism spectrum disorder
Asperger’s syndrome
Multiple learning difficulties
Other (Please specify below)
Mental health difficulty
Temporary disability after illness or
accident
Profound complex disabilities
Prefer not to say
Multiple disabilities
Other (Please specify below)
Prefer not to say
If other please specify:
Gender Status:
At Birth I was described as the same Gender to what I am now
At Birth I was described as a different Gender to what I am now
Other
Prefer not to say
Please ensure that if you are posting original documents that you send them via recorded delivery. Please note that the ASA is not
responsible for any items lost in the postal system. Original items will be returned to you by recorded delivery.
Please complete and return this form, together with the required evidence to: ASA Workforce Support Services, SportPark, 3
Oakwood Drive, Loughborough, Leicestershire, LE11 3QF or via email workforcesupport@swimming.org
Licence applications received after the renewal date (1st April 2016) will still be processed, however the licence period will not change
and the licence will expire on the 31st March 2017. A fee of £10 will be charged for any licence that has to be ‘fast-tracked’ through the
process. This will apply to any application that is received less than 10 working days prior to a course start date.