Date as Postmark

Dear Sir or Madam

Thank you for your enquiry regarding voluntary work with Northern Ireland Hospice.

Please find attached some information regarding volunteering opportunities which are available with our organisation.

If you are interested in applying to be a volunteer, please complete the enclosed application and monitoring forms and return them to:

The Volunteer Monitoring OfficerNorthern Ireland Hospice74 Somerton RoadBelfastBT15 3LH

Many thanks for considering the Hospice and I look forward to hearing from you soon.

Yours faithfully

_______________________Lorraine CrawfordVolunteer Services Admin

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Brief outline of VOLUNTEERING ROLES Adult Hospice Roles

Receptionist Dealing with visitors in person and on the telephone. Acknowledging cash donations. Contacting volunteers regarding rotas. Answering the telephone and directing calls to the relevant staff.

In-Patient Unit / IPU Care VolunteersPreparing trays for patients’ meals, taking menu orders, fetching drinks, topping up water jugs. Chatting and listening to patients and relatives. IPU Care volunteers, as previous role, but also provide personal care to patients and MUST have previous nursing or care experience.

Day Hospice (operates Tuesday/Wednesday/Thursday 9.30am – 2pm only)Assisting day care patients in a variety of recreational activities, Chatting and listening to patients, helping them with food and drinks. Taking menu orders. Assisting patients going to daily service.

DriverCollecting patients from their homes and bringing them to the Day Hospice, Hospice or hospital for out-patient appointments.

Patient Minibus Escort Accompanying patients in the minibus to and from Day Hospice. Chatting and reassuring patients being conveyed.

Transport OrganiserArranging transport for patients coming into Day Hospice and for outpatient appointments. . Contacting patients and drivers and completing necessary paperwork.

Café Volunteer Serving tea / coffee and other refreshments, selling items from the shop, operating the till and ensuring security and safe handling of all money. Re-stocking the confectionery and drinks from the cupboards as necessary. Ensuring the Café is kept clean and tidy, and that all dishes are washed and stacked away safely.

Flower ArrangerNo need to be an expert! Putting flowers into vases, topping up water, removing dead stems and washing vases.

Complementary TherapistProviding a service to patients and their families as a member of the Complementary Therapy Team

Library AssistantTo assist in ensuring that relevant library material is classified, catalogued, recorded and maintained.

Laundry HelperWashing and drying and if necessary ironing laundry and on occasions patients clothes in the Laundry room in Somerton. This role requires 2 volunteers to work alongside each other on a daily rota basis.

There are other roles for volunteers available for those with special interests and skills such as Finance, Craft/Art, Music, Hairdressing, Physiotherapy, Bereavement Visitor, Carers Befriender,

Retail Assistant, Gardener etc.

Fundraising and Promotional Roles for

Northern Ireland Hospice

Clerical Support To offer support with a wide range of in-house clerical duties such as photocopying, filing, answering telephones, packing envelopes, taking messages, making telephone calls.

Collection Box DistributorTo assist as part of a team with the collection and distribution of hospice collection tins. Having your own car would be a requirement for this role.

Cheque Presentations To represent Northern Ireland Hospice or Northern Ireland Children’s Hospice at cheque presentations organised by outside groups. This will involve saying thank you in public.

Speaking Opportunities To speak about the work of Northern Ireland Hospice or Northern Ireland Children’s Hospice or both services to groups and organisations by request. Training and tools to do this will be provided by the Fundraising Team.

Event Support Volunteer To marshal, give out refreshments, welcome people to an event, register participants, sell saleable items, direct, give out certificates at hospice events.

Data Input Assistant To accurately transfer, update, amend donor information on to hospice database (Raisers Edge).

Promotions and Collections at Shopping Centres, Theatres, etc. To assist the Fundraising Team to hand out promotional literature or to co-ordinate or actively collect at specific venues such as shopping centres.

To Become a Hospice Volunteer:

Find out all you can about the work of Northern Ireland Hospice e.g., Read literature, talk to staff

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Fill in an application form

êAttend Interview

è If unsuitable try anotherform of voluntary work.

If suitable

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Attend an Induction Course

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Become a trainee in selectedArea (s) of work

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Six month probation

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You are a service volunteer

NORTHERN IRELAND HOSPICE

VOLUNTEER APPLICATION FORMIN CONFIDENCE

PLEASE COMPLETE IN BLACK INK OR TYPESCRIPT APPLICATION REFERENCE NO.(For OFFICE use only)

TITLE (MR, MRS, MISS, MS, DR) FIRST NAME: SURNAME:

NATIONAL INSURANCE NUMBER: MAIDEN NAME: (IF APPROPRIATE) Are you age 17 or over? Yes No(You must be age 17 or over to volunteer in

Adult Services.)

HOME ADDRESS:

POSTCODE:

HOME TELEPHONE NO.

BUSINESS TELEPHONE NO.

MOBILE NO. EMAIL ADDRESS:

Name of Next of Kin in case of emergency: Relationship to you:

Contact Telephone No. Hm: Mob:

DO YOU OWN A CAR? YES / NO DRIVING LICENCE: FULL / PROVISIONAL

INSURANCE: COMPREHENSIVE / THIRD PARTY

PLEASE NAME TWO REFEREES WHO ARE NOT RELATED TO YOU WHO SHOULD HAVE KNOWLEDGE OF YOUR CHARACTER IN ORDER TO ANSWER QUESTIONS RELATING TO YOU.

NAME: NAME:

ADDRESS:

POSTCODE

ADDRESS:

POSTCODE

TEL NO. TEL NO.

EMAIL: EMAIL:

OCCUPATION: OCCUPATION:

FOR OFFICIAL USE ONLY:APPLICATION RECEIVED: ACKNOWLEDGED: INFORMATION:

INTERVIEW: REFERENCES:

ACCESS NI – Sent:

NO.

RETIRED:

IF YOU ARE CURRENTLY EMPLOYED PLEASE PROVIDE BRIEF DETAILS OF YOUR CURRENT EMPLOYMENT

JOB TITLE

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

POSTCODE

EMPLOYED: FULLTIME / PART-TIME

NO OF HOURS PER WEEK:

BRIEF DESCRIPTION OF DUTIES

ARE YOU PRESENTLY ENGAGED IN, OR HAVE YOU CARRIED OUT ANY VOLUNTARY WORK IN THE PAST?

HOW DID YOU HEAR ABOUT BECOMING A HOSPICE VOLUNTEER?

NEWSPAPER WORD OF MOUTH LEAFLET/WEBSITE

ANOTHER VOLUNTEER SERVICE USER/CARER MEDIA

CONNECT MAGAZINE OTHER: (PLEASE STATE)………………………………………………………………

WHY DO YOU WANT TO BECOME A HOSPICE VOLUNTEER?

PLEASE STATE THE QUALITIES AND SKILLS YOU BELIEVE YOU POSSESS THAT WILL ENABLE YOU TO UNDERTAKE THE VOLUNTEER ROLE(S) IN WHICH YOU ARE INTERESTED:

HAVE YOU SUFFERED ANY BEREAVEMENT RECENTLY?(IF YES, please give details as this information will help us to place you in an appropriate role)

HEALTH HISTORYYou will be visiting Northern Ireland Hospice on placement in the near future. As you may come in contact with patients, it is important that your health does not pose any risks, either for yourself or the patients and staff of the hospice.

I would therefore, be grateful if you would consider if any of the following situations are relevant to you:

If you are currently suffering from infectious illness such as chicken pox or German measles (Rubella) If you have recently been in close contact with someone suffering from such an illness. If you have any illness or you are on any treatment that might make you vulnerable to infection or if you have a

blood borne virus which may affect your ability to undertake exposure prone procedures.

If you think that any of these situations apply to you or you want other health advice relating to your placement please, contact Volunteer Services on (028) 90 78 18 36, your call will be dealt with confidentially.

WHEN WOULD YOU BE AVAILABLE TO VOLUNTEER ON A REGULAR BASIS? (Please tick times available)

Days Morning9 – 1pm

Afternoon1 – 5pm

Evening5 – 9pm

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

IN WHICH AREA OF VOLUNTEERING ARE YOU INTERESTED?

ADULT COMMUNITY

BELOW IS A LIST OF VOLUNTEER ROLES THAT ARE AVAILABLE, Please read the leaflet “Service Volunteer Roles” provided in your application pack to help you decide which role you may be interested in.

ADULT SERVICES ROLES do not place ticks or x in the boxes please select 3 choices ONLY i.e.: (if your 1st choice is IPU then place a 1 in the box beside IPU, and if your 2nd choice is Reception then place a 2 in the box and so on)

CAFÉ RECEPTION IN-PATIENT UNIT

DAY HOSPICE DRIVER MINIBUS ESCORT(Tues/Wed/Thurs 9.30am-2pm)

TRANSPORT ORGANISER MINIBUS DRIVER FLOWER ARRANGER

GARDENER ADMIN/CLERICAL/ IT KITCHEN HELPER

HAIRDRESSER FINANCE LAUNDRY HELPER

COMPLEMENTARY THERAPY

FUNDRAISING HOSPICE ROLES CLERICAL SUPPORT COLLECTION BOX FUNDRAISING

DISTRIBUTOR REPRESENTATIVE

EVENT SUPPORT VOLUNTEER DATA INPUT ASST PROMOTIONS AND COLLECTIONS (PUBLIC)

REHABILITATION OF OFFENDERS (EXCEPTIONS) ORDER NI 1979

The post you have applied for may be considerd as regulated activity. Is there any reason you cannot work in a regulated activity? YES/NO (*Regulated Activity is an activity that you must not do if you are barred from working with children or vulnerable adults).

If yes, please provide details: ……………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………….

Volunteer roles are exempt from the provision of Section 4 (2) of the Rehabilitation of Offenders Act by an Exception Order. Applicants therefore are not entitled to withhold information about convictions which for other purposes under the Act are “spent”. Failure to disclose could result in you being asked to leave your volunteering role in Northern Ireland Hospice.

DO YOU HAVE ANY CRIMINAL CONVICTIONS? YES NO

IF YES, PLEASE GIVE DETAILS ABOUT ALL CONVICTIONS WHICH ARE REGARDED AS CRIMINAL OFFENCES.

A copy of the NIH policy on ‘Recruitment of Ex-offenders’ may be obtain by contacting the Human Resources Department.

IT SHOULD BE NOTED THAT DISCLOSURE OF A CONVICTION DOES NOT NECESSARILY DEBAR YOU FROM VOLUNTEERING

NB: FAILURE TO COMPLETE THIS FORM MAY RESULT IN YOUR APPLICATION NOT BEING SHORTLISTED

Data Protection StatementThe information that you provide on this form and that obtained from other relevant sources will be used to process your application. The personal information that you give us will also be used in a confidential manner to help us monitor our recruitment process. If you succeed in your application, the information will be used in the administration of your involvement with us and to provide you with information about us. We may also use the information if there is a complaint. We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing the application form we will be assuming that you agree to the processing of sensitive personal data, (as described above), in accordance with the Data Protection Act.

DECLARATION

I DECLARE THAT TO THE BEST OF MY KNOWLEDGE THE INFORMATION GIVEN IS HONEST AND ACCURATE.

I CONFIRM THAT THERE ARE NO MEDICAL REASONS WHICH WOULD PREVENT ME FROM UNDERTAKING THE DUTIES OF THIS ROLE.

I UNDERSTAND THAT ANY FALSE/MISLEADING STATEMENT AND/OR OMISSION ON THIS FORM MAY RESULT IN MY APPLICATION BEING REJECTED OR IF I HAVE ALREADY TAKEN UP MY VOLUNTEER ROLE, BEING ASKED TO LEAVE.

AND

I UNDERSTAND THAT ACCEPTANCE AS A VOLUNTEER IS SUBJECT TO RECEIPT OF SATISFACTORY VETTING PROCEDURES AND PROBATIONARY PERIOD.

I ALSO UNDERSTAND THAT APPOINTMENT MAY BE SUBJECT TO THE SATISFACTORY COMPLETION OF EITHER A STANDARD OR AN ENHANCED ACCESSNI SECURITY DISCLOSURSE (further details on this may be found in the AccessNI Code of Practice, available on www.nidirect.gov.uk/accessni-code-of-practice.pdf?rev=0 or upon request from the Human Resources department).

SIGNATURE …………………………………………………………………………… DATE ………………………………….

Send this form with the Equal Opportunities Monitoring Slip to:

The Volunteer Monitoring OfficerNorthern Ireland Hospice74 Somerton RoadBelfast BT15 3LH

The volunteer role you have applied for may be considered as regulated activity. Is there any reason you cannot work in a regulated activity? YES/NO (*Regulated Activity is an activity that you must not do if you are barred from working with children or vulnerable adults).

If yes, please provide details: …………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………….

FAILURE TO COMPLETE THIS SECTION WILL RESULT IN YOUR APPLICATION BEING REJECTED

NORTHERN IRELAND HOSPICE EQUAL OPPORTUNITIES MONITORING SLIP

Northern Ireland Hospice is committed to equality of opportunity for all applicants irrespective of race, ethnic origin, sex, martial or parental status, sexual orientation, creed, disability, age or perceived religious or political affiliation. The Hospice will however select candidates solely on the basis of merit, i.e. the best person for the role.

It is therefore necessary for the Hospice to monitor its activities to ensure that the requirements under the Equal Opportunities Policy is effectively implemented.

PLEASE INDICATE YOUR COMMUNITY BACKROUND BY TICKING THE APPROPRIATE BOX

PROTESTANT ROMAN CATHOLIC OTHER

PLEASE INDICATE YOUR GENDER BY TICKING THE APPROPRIATE BOX:

PLEASE INDICATE YOUR MARITAL STATUS BY TICKING THE APPROPRIATE BOX

MALE FEMALE

SINGLE MARRIED WIDOWED

DIVORCED SEPARATED

PLEASE INDICATE YOUR ETHNIC BACKGROUND BY TICKING THE APPROPRIATE BOX:

APPLICATION REFERENCE No.(For Employers Use Only)

WHITE EUROPEAN CHINESE IRISH TRAVELLER

INDIAN PAKISTANI BANGLADESHI

BLACK CARIBBEAN BLACK AFRICAN BLACK OTHER

OTHER POLISH

THIS INFORMATION WILL BE TREATED IN THE STRICTEST CONFIDENCE AND USED FOR MONITORING PURPOSES ONLY

PLEASE INDICATE HOW YOU BECAME AWARE OF THIS OPPORTUNITY……………………………………………………

IF YES, PLEASE GIVE BRIEF DETAILS .………………………………………………………………………………….…………….

HAVE YOU ANY PHYSICAL OR OTHER DISABILITY: YES / NO

DATE OF BIRTH / /