Charity registration number 263281

Chairman Tim Fagg CEO Jennie Double

Volunteer application form

Thank you for your interest in volunteering with our Organisation. Volunteers play a vital role in the delivery of our programmes, which ensure that older people have opportunities to socialise , enhance existing skills and interests and develop new skills, supporting them to live productive and meaningful lives.

Name

Address

Post Code

Telephone Home Mobile

Email address

Age 18 to 25 26 to 35 36 to 50 50 to 60 60+

Do you have a full current driving licence? YES / NO

If you are involved with us a volunteer and an emergency arises who would we need to contact?

Name Relationship

Contact details

Are you normally available during ;

The Morning Afternoon Evening All day

Status (please circle)

Unemployed Working Full Time Long term disabled

Retired Semi Retired Other (please specify below)

Please outline any relevant skills, interests, hobbies , previous experience:

How did you find out about Volunteering Work with us?

What are your reasons for volunteering?( Please circle your response).

To gain work experience To get more involved with the Community

To develop new skills To make new friends

To build up confidence To maintain existing skills

Additional reasons or comments

When would you be able to start volunteering?

In order for us to offer you the appropriate level of support in your volunteer role, please advise of any health problems or medical conditions that you think might affect the type of duties that we offer you.

In both the interests of yourself and the people with whom you will be working we require a reference from two people , who have known you for atleast two years. These referees cannot be family members.

Name Name

Address Address

Telephone Number Telephone Number

How are they known to you? How are they known to you?

May we contact them on receipt of this application form? YES/NO

As an agency providing support to vulnerable people our volunteer roles are exempt fomr the provisions of the Rehabilitation of Offenders Act 1974. You must disclose all conviction including spent conviction.

Have you ever been convicted, warned or cautioned for a criminal offence, or liable in a Civil case? YES/NO

If yes please give details on a separate sheet (in strictest confidence)

Do you give your consent for us to carry out a Criminal Records Bureau check YES/NO

Information disclosed in this form is subject to the Data Protection Act 1998. We do not pass on any information about you to anyone without your informed consent.

I certify that the information that I have shared on this application form is correct

Signed Date

Age UK Ashford;

Incorporating the Eldercare Centre , Stanhope Road, Ashford, Kent TN23 5RF

Manager ; Diana Tritton 01233 642094

& the - Joe Fagg Pop Inn, St Johns Road, Ashford, Kent TN23 1QD telephone 01233 620635 email Manager; Ann Hunter