Application Form for Chaplaincy Volunteerrole

APPLICATION FORM FOR CHAPLAINCY VOLUNTEERROLE

PERSONAL INFORMATION:
TITLE (MS, MR, MISS OTHER): / FIRST NAME/S;
SURNAME: / DATE of BIRTH:
ADDRESS:
POST CODE: / EMAIL
PHONE NUMBER/S: / HOME:
WORK: / MOBILE
ADDITIONAL INFORMATION:
1. Please outline something of your Christian faith journey and why you are applying to be a chaplaincy volunteer?
2. Give a brief overview of you work experience in the past and currently? (voluntary, paid, at home)
3. What interests / hobbies / skills could you use in the role of chaplaincy volunteer?
4. Having read the enclosed role description and looked at information about the social work services on the website are there any tasks / areas which particularly interest you?
HEALTH
5. Do you have any health problems, physical or mental, that might cause difficulties when volunteering? If so please give details.
The information given here will be treated in strict confidence and only used in relation to the position you are seeking with us.
PREVIOUS CONVICTIONS / OFFENCES:
If you are accepted as a volunteer you will be working with vulnerable adults. Therefore is there anything current or in the past regarding any criminal record?
Yes / No / If yes, please detail the incidents below.
The information given here will be treated in strict confidence and only used in relation to the position you are seeking with us. A current Enhanced DBS clearance will be required.
REFERENCES
Please name two people who would be willing to provide references, at least one of whom should be a Christian leader.
Name: / Name:
Address: / Address:
Phone: / Phone:
Email / Email
May we contact this referee prior to interview? / Yes / No / May we contact this referee prior to interview? / Yes / No

Finally: If you are selected to become a volunteer, you will be expected to adhere to the organisation’s confidentiality policy and not to disclose any information about our service users to anybody outside of work.

Signature: ______Date: ______

Please send this form to: or post to Laura Muzorori, West London Mission, 19 Thayer Street, London, W1U 2QJ