Winter Shelter Application Form (2017/2018)

WINTER SHELTER APPLICATION FORM (2017/2018)

SECTION 1

Please click on the boxes where appropriate.

Your details

Name:

/

Address:

/
/

Post Code:

/

Telephone number:

/

Mobile:

/

Email:

/

Are you over 18 years of age?

/

Yes ☐ No ☐

/

(Please note that you must be 18 years of age or over to volunteer in the Winter Shelter)

My gender is:

/

Female ☐ Male ☐

Details of someone we can contact on your behalf in the case of an emergency

Name:

Address:

/
/

Post code:

Landline telephone number

/

Mobile number:

/
Yes / No
Are you currently accessing support that might be similar to services provided by Emmanuel House or the Winter Shelter? / ☐ / ☐
If ‘yes’ please give details.
Do you have any allergies? / ☐ / ☐
If ‘yes’ please give details.
Are you taking any medication over the long term? If ‘Yes’ please give details. (If you are prescribed medication at the time of volunteering you are required to declare it.) / ☐ / ☐
If ‘yes’ please give details.

Declaration

Yes / No
Have you ever been convicted of a criminal offence? / ☐ / ☐
If ‘yes’ please give details.
References
Please send the reference pack on the website to two people who are willing to be your Referee and who know you well. They must not be a family member or partner, someone else who volunteers or works in the Shelter or Emmanuel House but can include a friend, colleague, Minister, workers, GP’s etc. In case we need to follow up your referee please provide their details below.
Referee 1

Name:

/

Address:

/
/

Post code:

/

Telephone number:

/

Mobile:

/

Email address:

/

In what capacity do you know this person?

/
Referee 2

Name:

Address:

/
/

Post code:

/

Telephone number:

/

Mobile:

/

Email address:

/

In what capacity does this person know you?

/
Yes / No
I have sent the reference pack to my referees / ☐ / ☐

Section 2

If you have not filled in SECTION 1 insert your name here.

Please indicate all the Winter Shelter venues you can volunteer by putting an ‘X’ in the box

2017 / 2017/18 / 2017/2018
13th Nov-11th Dec / 11th Dec-8th January
Please see below for availability during Christmas and New Year weeks / *Dates TBC* / *Dates TBC* / *Dates TBC* / *Dates TBC*
The Arches
Lenton Lane NG7 2PX
Click here for map and location / Thomas Helwys Baptist Church
Lenton NG7 1SJ
Click here for map and location / St Saviour’s Community Hall, The Meadows NG2 2JU
Click here for map and location / Mansfield Road Baptist Church, Gregory Boulevard, Sherwood Rise, NG7 6JN
Click here for map and location / St Christopher’s Hall Sneinton NG2 2JU
Click here for map and location / Friends Meeting House 25 Clarendon St, Nottingham NG1 5JD
Click here for Map and location
☐ / ☐ / ☐ / ☐ / ☐ / ☐
Please indicate the times when you are available to volunteer in the week by putting an ‘X’ in the box.
Morning session 7.00am -8.15.am.
Evening session 8.00pm-10.30pm / Monday / Morning / ☐ / Thursday / Morning / ☐ / Sunday / Morning / ☐
Evening / ☐ / Evening / ☐ / Evening / ☐
Tuesday / Morning / ☐ / Friday / Morning / ☐
Evening / ☐ / Evening / ☐
Wednesday / Morning / ☐ / Saturday / Morning / ☐
Evening / ☐ / Evening / ☐
Please put the maximum number of sessions you want to do in a week / (Click on the ‘0’) I am available for 0 sessions per week.
Yes / No
If you have not indicated in your general availability that you can volunteer at weekends but you feel you could offer one or two weekend sessions please mark the appropriate answer/s. You will always be asked about your availability beforehand. / Please approach me about 1 Saturday morning in the Shelter season / ☐ / ☐
Please approach me about 2 Saturday mornings in the Shelter season / ☐ / ☐
Please approach me about 1 Sunday morning in the Shelter season / ☐ / ☐
Please approach me about 2 Sunday mornings in the Shelter season / ☐ / ☐
Please indicate if you are available over the Christmas and New Year period / Monday 18th Dec / Morning / ☐ / Thursday 21st Dec / Morning / ☐ / Sunday 24th Dec
Christmas Eve / Morning / ☐
Evening / ☐ / Evening / ☐ / Evening / ☐
Tuesday 19th Dec / Morning / ☐ / Friday 22nd Dec / Morning / ☐ / Monday Morning☐
25th Dec Evening ☐
Christmas
Day
Evening / ☐ / Evening / ☐
Wednesday 20th Dec / Morning / ☐ / Saturday 23rd Dec / Morning / ☐
Evening / ☐ / Evening / ☐
Tuesday 26th Dec
Boxing Day / Morning / ☐ / Friday 29th Dec / Morning / ☐ / Monday 1 Jan
New Year’s Day / Morning / ☐
Evening / ☐ / Evening / ☐ / Evening / ☐
Wednesday
27th Dec / Morning / ☐ / Saturday 30th Dec / Morning / ☐
Evening / ☐ / Evening / ☐
Thursday
28th Dec / Morning / ☐ / Sunday 31st Dec
(New Year’s Eve) / Morning / ☐
Evening / ☐ / Evening

Short notice list

On occasions when volunteers are unable to attend a session we look to fill the sessions at short notice. Please indicate ‘Yes’ or ‘No’ if you can offer to be a short notice volunteer. / Yes / No
For the times I have indicated above I can be contacted at short notice for morning sessions / ☐ / ☐
Are you able to help us with laundry? / Yes☐ / No ☐

Winter Shelter Training

Training Guidelines:
o  All volunteers (existing and new) are required to attend the compulsory Food Hygiene training, please book onto one of the following sessions:
Thursday 2 Nov 17, 7pm-9.30pm
@ The Arches, Lenton Lane, Nottingham NG7 2PX / ☐
Saturday 11 Nov 17, 10.30am-1pm
@ Emmanuel House, 53-61 Goosegate, Nottingham NG1 1FE / ☐
Saturday 2 Dec 17, 10.30 am-1pm
@ St Saviour’s Community Hall, The Meadows NG2 2JU / ☐
Thursday 1 Feb 18, 7pm-9.30pm
@ Emmanuel House, 53-61 Goosegate, Nottingham NG1 1FE / ☐
The information I have provided is accurate to the best of my knowledge
Print name:
Signature:
(Your email address is accepted as your signature.)
Date:

SECTION 3

Nottingham Winter Shelter Volunteer Recruitment Monitoring Form

This part of application form will NOT be used in any recruitment process.

Emmanuel House and Nottingham Winter Shelter are committed to the development of positive policies to promote equal opportunities in employment, volunteering and in the delivery of our services, regardless of race, disability, gender, belief or religion, age, pregnancy and maternity, gender reassignment, marriage and civil partnership or sexual orientation. One aim of this policy is to make sure that you and other applicants are not discriminated against. The policy also aims to make sure that you are not disadvantaged by conditions or requirements that are not relevant. Please provide feedback by clicking the relevant boxes.

Gender / Faith
Male / ☐ / Baha'i Faith / ☐
Female / ☐ / Buddhism / ☐
Your age / Christianity / ☐
16-25 / ☐ / Hinduism / ☐
26-35 / ☐ / Islam / ☐
36-45 / ☐ / Judaism / ☐
46-55 / ☐ / Rastafarianism / ☐
56 and over / ☐ / Sikhism / ☐
Ethnicity / Zoroastrianism / ☐
White / ☐ / Other Religion / ☐
White British / ☐ / None / ☐
White Irish / ☐ / Sexual Orientation
White Other / ☐ / Heterosexual/Straight / ☐
Duel Heritage / Gay man / ☐
Dual Heritage Caribbean / White / ☐ / Gay Woman/Lesbian / ☐
Dual Heritage African / White / ☐ / Bisexual / ☐
Dual Heritage White / Asian / ☐ / Transsexual / ☐
Other Dual Heritage / ☐ / Transgender / ☐
Chinese / Other / ☐
Chinese / ☐ / Prefer not to say / ☐
Asian / Disability
Indian / ☐ / Do you have a disability? - No / ☐
Pakistani / ☐ / Do you have a disability? - Yes / ☐
Other Asian / ☐
Black
Caribbean / ☐
African / ☐
Other Black / ☐
Other ethnic group / ☐
How did you find out about volunteering in the Winter Shelter?
Someone told me about it / ☐ / Local Press / ☐
Emmanuel House / ☐ / National Press / ☐
My faith group/organisation / ☐ / Notts TV / ☐
Community group/centre/event / ☐ / BBC Nottm/Central TV / ☐
Student volunteer centre (Uni of Nottm) / ☐ / Emmanuel House website / ☐
Student volunteer centre (Trent Uni) / ☐ / Other website / ☐
Volunteer Centre Nottm CVS / ☐ / Facebook / ☐
Emmanuel House / ☐ / Twitter / ☐
Emmanuel House leaflet/poster / ☐

Please return the form to: and put ‘Application for Winter Shelter’ in the subject box or a hard copy to:

Emmanuel House, 53-61

Goose Gate,

Nottingham NG1 1FE