What role are you applying for? / Events Volunteer
Which event(s) would you like to volunteer at?
If there are specific times/shifts for the events you wish to volunteer at, please include these as well.
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How did you find out about volunteering with us? (please put a X in the relevant box)
Friend/Family / ☐ / I am/was a patient at this hospital / ☐
A member of NHS staff / ☐ / I am a donor for Imperial College Healthcare Charity / ☐
A volunteer / ☐ / Imperial College Healthcare Charity email / ☐
NHS website / ☐ / Via a poster/leaflet in one of the hospitals / ☐
Imperial College Healthcare Charity website / ☐ / Online volunteering website / ☐
Facebook/Twitter or other social media / ☐
Other / Click here to enter text.
Your personal information
Title / Click here to enter text. / First Name / Click here to enter text.
Known as name / Click here to enter text. / Surname / Click here to enter text.
Email address / Click here to enter text.
Home Address / Click here to enter text.
Postcode / Click here to enter text.
Telephone (day) / Click here to enter text.
Telephone (evening) / Click here to enter text.
Telephone (mobile) / Click here to enter text.
Date of birth / Click here to enter a date. / We only use this information to confirm that you are over the age of 18
Availability
Please put a X in the relevant box.
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
AM / PM / AM / PM / AM / PM / AM / PM / AM / PM / AM / PM / AM / PM
☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Your health (including dietary requirements)
(it is important that you tell us about any health issues, including mental health, significant illness, or any disability where we might need to make special arrangements – please be aware that due to the physical nature of some of our roles and the accessibility of some of our locations we may find it difficult to accommodate you)
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Do you have any additional support needs that we should be aware of?
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Rehabilitation of Offenders Act 1974
Please put a X in the relevant box.
Do you have any unspent criminal convictions registered against you? / No / ☐ / Yes / ☐
If you have answered Yes to this question, this may not necessarily prevent you volunteering, but please provide details of any conviction or current investigation in a sealed envelope addressed confidentially to the Volunteering Department, Charity Office, Ground Floor, Clarence Memorial Wing, St Mary’s Hospital, Praed Street, London W2 1NY or call the Head of Volunteering in confidence on 020 3112 2037.
Volunteering Experience
Do you hold any other voluntary roles with different organisations?
Details
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Have you volunteered with Imperial College Healthcare Trust/Charity at this or another hospital previously? / Yes / ☐ / No / ☐
Details
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Personal Statement / Please provide as much information as possible as this section will be used to assess your suitability for the role you are applying for. Feel free to use an additional A4 sheet if you require more space.
Please tell us about why you would like to volunteer with us?
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Please tell us about your skills and experience relevant to this role
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Are there any aspects of the role where you feel you would need a bit more support or training?
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Emergency contact / please supply the details of someone we can contact in case of emergency while you are volunteering with us
Title / Click here to enter text. / First Name / Click here to enter text.
Surname / Click here to enter text.
Address / Click here to enter text.
Postcode / Click here to enter text.
Telephone / Click here to enter text.
Relationship to you / Click here to enter text.
Referees / Please provide the details for two referees and ensure you have their permission for us to contact them. Referees should include a previous employer, college/school tutor, previous volunteer manager or someone who holds a position of responsibility in the community. One of these should have known you for at least two years. We cannot accept family members, friends or people you live with as referees.
Title / Click here to enter text. / Title / Click here to enter text.
First Name / Click here to enter text. / First Name / Click here to enter text.
Surname / Click here to enter text. / Surname / Click here to enter text.
Address / Click here to enter text. / Address / Click here to enter text.
Postcode / Click here to enter text. / Postcode / Click here to enter text.
Occupation / Click here to enter text. / Occupation / Click here to enter text.
Telephone / Click here to enter text. / Telephone / Click here to enter text.
Email / Click here to enter text. / Email / Click here to enter text.
How do they know you? / Click here to enter text. / How do they know you? / Click here to enter text.
How long have they known you? / Click here to enter text. / How long have they known you? / Click here to enter text.
Your clothing size / For some events we provide a volunteer uniform or branded clothing to wear, please provide your top size
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Declaration
Please put a X next to each statement to confirm you have read and understood this declaration.
I understand that Imperial College Healthcare Charity will use my information for administration and to keep in touch with me about their charitable activities in accordance with the Data Protection Act 1998. / ☐
I understand that if I am successful in my application my information may be disclosed to Imperial College Healthcare Charity employees, their agents, NHS employees or Emergency Services personnel if necessary. / ☐
I am happy for Imperial College Healthcare Charity to send me a copy of their newsletter via email and post. / ☐
I understand that the taking of photographs, video and audio recordings will take place at events and I am happy for images/recordings of me to be used by the charity to promote volunteering. / ☐
I confirm that I have completed this volunteer application with wholly accurate information at the time of submission and understand the process for recruiting and selecting volunteers for Imperial College Healthcare Charity.
Signed / Click here to enter text. / Date / Click here to enter a date.
When submitting this form electronically please type your name in place of a written signature, we will ask you to sign a printed copy if you are successful.
Imperial College Healthcare Charity is a registered charity in England and Wales, no 1166084
Charing Cross * Hammersmith * Queen Charlotte’s & Chelsea * St Mary’s * Western Eye
Volunteering at Imperial College Healthcare Charity