Volunteer Application Form

Personal Details

First Name(s) / Last Name(s)
Date of Birth
Address
Postal code
Tel no: (home) / Tel. no: (work)
Mobile no: / Email:
STATUS: (Please tick any of the boxes below that apply)

Retired: Unemployed:

Working full time: Working part time:
Student: Asylum seeker:
Other (Please specify) ......

Car Owner

Do you have a current full driving licence?
Yes No
Do you have a car that you would be prepared to use when volunteering?
Yes No
Why did you choose to be a volunteer with Age UK Newcastle?
What skills, interests, hobbies and previous experience do you have?
Do you know which area of volunteering are you interested in?
please see our website for information: http://www.ageuk.org.uk/newcastle/how-you-can-help-us/volunteer-for-us/
We would recommend you attend a Volunteering Open Day to get more information. Have you attended an open day ?
I have already attended an Open Day
I would like to attend a future Open Day
I would not like to attend an Open day
How much time do you have available for volunteering?
Please indicate the days and times that are most convenient to you.
Days: hours:
When will you be able to start volunteering?......

What are your reasons for volunteering?

(please tick any of the boxes below that apply)
To build up my confidence: To help older people:
To develop new skills: To improve knowledge
of care work:

To gain work experience: To make new friends:
To get involved in the To maintain existing
Community: skills:
Other (please provide details)......
......
......
How did you find out about voluntary opportunities with Age UK Newcastle?
(please tick any of the boxes below that apply)
Article In Newspaper: Poster:
Exhibition: Press Advert:
From An Age UK Customer: Referred by A Friend:
Internet: Talk Or Presentation:
Leaflet: TV Or Radio Item:
Placement Opportunities: Volunteer Bureau:
Other (Please Provide Details)......
......
......

References

In both the interest of yourself and the people with whom you will be volunteering, we require a reference from at least two referees who have known you for at least two years. These referees must not be family members.
If your circumstances mean that you are unable to provide references, please let us know so that we can discuss other options with you.
Reference 1
Name:
Address:
Post code:
Telephone number:
Email:
Relationship:

Referee 2

Name:
Address:
Post code:
Telephone number:
Email:
Relationship:

Emergency contact:

Please ensure that this person has given their permission for us to contact them in an emergency.

Name:
Address:
Telephone no:
Email:
Relationship to you:

Criminal convictions

Rehabilitation of Offenders Act 1974

As an organisation supporting vulnerable people, volunteering posts may be considered exempt from the provisions of the Rehabilitation of Offenders Act 1974 and any convictions must be declared. You must disclose all previous convictions, none of which may be considered “spent”.
Please note that possession of a criminal record may not necessarily prevent you from being taken on as a volunteer but may limit the volunteering opportunities that Age UK Newcastle can offer you.
Have you ever been convicted, warned, reprimanded or cautioned of a criminal offence or liable in a civil case?
Yes No
If “yes”, details may be required from you on a separate sheet in strictest confidence.
We will require a DBS (formerly CRB) disclosure check. Do you give your permission for us to carry out such a check if appropriate?
Yes No

Data Protection Act 1998

Information on our database is strictly confidential and we do not pass on any personal data about you to outside organisations or individuals without your expressed personal consent. Please indicate if you agree that we may:
Keep basic information from this form on computer?
yes no
Send you updates and more information about Age UK Newcastle?
yes no
Declaration

I certify that all of the information given on this form is correct.

Signature: Date:

Thank you for your interest in volunteering with Age UK Newcastle.

Please return this form in the pre-paid envelope, if provided, or to:
Age UK Newcastle, 5th floor, Hadrian House, Higham Place,
NEWCASTLE UPON TYNE, NE1 8AF