Volunteer Application Form

Please complete this application form as fully as you can

Volunteer Position Applied For / Preferred Location
Full Name / Title / (Mr/Mrs/Ms/Dr)
How did you hear about this opportunity
Full Address
Post Code
Home Telephone / Work Telephone
(if applicable)
Mobile
Email Address
Education and Training
Please give details of any educational, or professional qualifications which might be applicable to your chosen volunteer role. Or any other relevant qualifications, training or courses attended
Present Occupation (please tick as appropriate)
Employed / Student
Non-employed
(not seeking paid work) / Jobseeker/Employment Support Allowance (please specify)
Retired / Other please specify

Do you have any experience volunteering?

What interests you about becoming a volunteer at Open Road?


What do you hope to achieve from volunteering at Open Road (eg do you want to gain work experience, or are you looking to increase your daily activity)? There are no right or wrong answers

What are your hobbies and interests?

If you are applying to be a Volunteer Counsellor or Volunteer Body Therapist, please give details of your relevant qualifications below:

Criminal Offences
Have you ever been convicted of any criminal offences, which are not deemed spent under the terms of the Rehabilitation of Offenders Act 1974? / YES / NO
If yes, please give details
An enhanced Criminal Record Bureau Check will be required, however Open Road are committed to supporting former service users into volunteering and do not see criminal records as a barrier to becoming part of the recovery volunteering team at Open Road. CRB disclosures will be viewed on an case by case basis.
References
Please give details of two referees. Due to the nature of the service we provide we require one personal reference and one professional reference.
The professional reference can be from an employer, former employer, colleague, ex colleague, a professional (e.g. Social Worker, Probation Officer, GP, Solicitor, Religious Representative, or Teacher), or anyone who has known you in a professional capacity.
The personal reference can be from a friend but not a family member.
Reference 1 - Professional / Reference 2 - Personal
Name / Name
Position / Position
Company Name / Company Name (if applicable)
Address / Address
Post Code / Post Code
Tel No / Tel No
Email (Preferred) / Email (Preferred)
I give / do not give permission to take up my reference prior to an initial informal interview being undertaken (delete clearly as appropriate) / I give / do not give permission to take up my reference prior to an initial informal interview being undertaken (delete clearly as appropriate)
Data Protection Statement
The information that you provide on this form and that obtained form other relevant sources will be used to process your application for volunteering. The personal information that you give us will also be used in a confidential manner to help us monitor our volunteer recruitment process. If you succeed in your application and take up volunteering with us, the information will be used in the administration of your volunteering with us and to provide you with information about us or third party where appropriate. We may also use the information if there is a complaint or legal challenge relevant to this volunteer recruitment process.
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 1998.
Undertaking
I confirm that the entries that I have made on this application form are, to the best of my knowledge and belief, true. I understand that, should I have deliberately made a false statement on this form, any volunteering offer could be withdrawn, or the continuation of volunteering put at risk.
I authorise the Company to process and store all information contained on this application form for the purpose of volunteer recruitment.
I authorise the Company to obtain references to support this application (subject to the restrictions above) and release the Company and referees from any liability caused by giving and receiving information.
Signature / Name
Date

Please now complete the Equal Opportunities Monitoring Form on the next page.

Please email your application to

Alternatively, post your application to:

Nicola Estall, Open Road, 12 North Hill, Colchester, CO1 1DZ

Thank you for your application and for your interest in the Open Road.

We will respond to your application as soon as possible.

Equal Opportunities Monitoring
This section of the application will be detached from your application and will be used solely for monitoring purposes, or to allow reasonable adjustments to be considered and made with regards to disability.
The Company recognises and actively promotes the benefits of a diverse workforce, both paid and voluntary, and is committed to treating all employees/volunteers with dignity and respect regardless of race, gender, disability, age, sexual orientation, religion or belief. We therefore welcome applications from all sections of the community.
If you are descended from more than one ethnic group, please tick the group to which you consider you belong. Or tick the ‘Any other ethnic group’ box and describe your ethnicity in the space provided.
White / Bangladeshi
Irish / Pakistani
Black – Caribbean / Indian
Black – African / Chinese
Black – Other
(please specify) / Any other ethnic group
(please specify)
Date of Birth
Do you consider yourself to have a disability? / YES / NO
If you wish, you may disclose information about yourself in this section about your religion or sexual orientation:
Thank you for completing our Equal Opportunities Monitoring Form.

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