Volunteer application form

Name*

Prefix First Last

Address*

Address line 1 Address line 2 Town County Postcode

Occupation

Phone

Mobile phone

Is it alright for us to telephone you at work?

Yes
No/not applicable

Have you done any voluntary work before?

Yes
No

If you answered yes, please tell us what you have done

Have you any experience of people with a learning disability?

Yes
No

If you answered yes, please give details

Why would you like to become a volunteer?

Which department are you interested in volunteering in? Please tick those that apply

Open Door
Social Clubs
Active Arts
Westwood
Charity Shop

What would you like to gain from your volunteering experience?

Work history

Date started	Date finished	Description

Please give a short description of what you have been doing with your life since leaving school - i.e. your employment, volunteering and education history.

Skills and experience

Please write down the skills/experience or training which you have to offer. Use your work outline to complete this section.

Special skills and interests

Please outline any special skills/interests you have to offer; also state anything that you do not like doing.

What times are you available?

What time do you have available for volunteering? Please tell us if you are available for specific hours/days or even weeks/months.

Training

Training is provided for Volunteers. What would you hope to gain from this?

Do you own a car/have use of a car?

Yes
No

If you have a car, are you prepared to use it whilst volunteering? (Mileage expenses paid)

Yes
No

How did you find out about volunteering?

Health information

Do you consider yourself disabled?

Yes
No

Disability adjustments

Please detail any reasonable adjustments you are aware of that you would like the company to consider.

Work absences

Please list all absences from work in the past 12 months and the reasons for such absences.

References

Please give details of two people (not relations) who can provide a character reference for you. Contact to your referees will be by writing in confidence and may be followed up with a phone call.

Name - Reference 1

Prefix First Last

Address - Reference 1

Address line 1 Address line 2 Town County Postcode

Daytime phone - Reference 1

Evening phone - Reference 1

Name - Reference 2

First Last

Address - Reference 2

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Daytime phone - Reference 2

Evening phone - Reference 2

Criminal record

We are committed to best practice in volunteer recruitment and will ensure that those working directly with people, as a volunteer, are appropriately screened. Please note that a criminal record will not necessarily prevent you from working as a volunteer. However, because of the vulnerability of some of the people with whom we work, we reserve the right to conduct checks as deemed necessary.

Convictions

Please note any criminal convictions, except those spent under the Rehabilitation of Offenders Act 1974. If none, please state.

Privacy statement

Please take time to read the attached privacy statement.

The information provided on this application form will remain confidential and will be used for the purpose of selection. By signing this form you will be giving your consent for us to process your data in accordance with the General Data Protection Regulations as set out in the Society’s privacy statement.

Declaration
I declare that to the best of my knowledge and belief, all particulars I have given are complete and true. I understand that any false declaration or misleading statement or any significant omission may disqualify me from volunteering and render me liable to dismissal. I understand that any offer is subject to satisfactory references and a probationary period and (where appropriate) a satisfactory medical report. I understand that if this post involves direct working with people with a learning disability, the post is subject to a Criminal Records Check (Disclosure). Should I be offered such a post, I understand that I will need to seek a Criminal Record Check from the Criminal Records Bureau, before the appointment is confirmed.

I have read and agree to the declaration*

Please tick

Date

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Comments

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Health information

References

Criminal record

Privacy statement

Contact numbers

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Where to find us

Our open hours

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