City and Hackney Mind Volunteer Application Form

The information given on this form will be kept confidential within City and Hackney Mind .

Please complete this form in block capitals. Please feel free to continue on additional sheets, if necessary, and if you wish you may also attach a C.V

Name:

Role Applied for:Address:

Postcode:

Telephone number:Email address:

Please say why you wish to become a volunteer for this service?

What do you think could help an older person feel less lonely and socially isolated?

Please say what you think you could bring to this service and what you wish to gain from the experience (you can refer to the role description here):

What are your hobbies and interests?

Employment, qualifications & training

Please list below details of previous employment/voluntary work, starting with the most recent first, please feel free to attach your CV if you would prefer:

Employers Name & Address

Post held and a very brief description of duties

Dates (From – To)

The successes of many services are dependent on reliability and commitment. Are you able to commit yourself to working on a regular basis?

YES/NO

Volunteers for this project are asked to commit to a minimum of 12 months and approximately 7 hours per week. Please tick the appropriate box(es) of the week you are available.

DAY MON TUE WED THURS FRI SAT SUN

MORNING

AFTERNOON

EVENING

How did you hear about this volunteering opportunity?Volunteer Centre

Poster/Leaflet Where?..................................................

Word of Mouth

Other (please state) ………………………………………………………………….

Please provide details of two people, who are willing to act as referees, one should have known you for at least two years. One of the references should ideally be from a previous employer, either paid/voluntary.

1. Name:Position:In what capacity do you know this person?Address:Telephone:Email:

2. Name:Position:In what capacity do you know this person?Address:Telephone:Email:

DBS disclosureApplications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this volunteering position will not be taken into consideration, but you are required to disclose any convictions, which are not by virtue of the Rehabilitation of Offenders’ Act 1974.

Have you been convicted of any criminal offence?

YES/NO* delete as appropriate- If yes, please give brief detail below:

If you are successful at interview and you are offered a volunteering post, an Enhanced DBS check will be carried out.

DeclarationI confirm that all the details I have provided in this application form are correct, and that I have not deliberately withheld any relevant information.

I understand that deliberately providing false information, failing to disclose relevant information or attempting to influence the recruitment process unfairly may lead to my application being rejected, any offer of employment (whether paid or unpaid) being withdrawn, or actual employment (whether paid or unpaid) being terminated;

I note that the information provided on this application form may be held, further processed or verified in accordance with the Data Protection Act 1998.

Signature__________________________ Date___________________________