Colchester Community Voluntary Services

“Part of the Essex Timebank Partnership”

TIME BANK

Application Form

Please complete this form in BLOCK capitals

Personal Details
Title / First Name / Last Name
Address Line
Town / County / Post Code
Home Telephone / Mobile
Email Address (Please write clearly)
Date of Birth / Gender / Male / Female
Please give details of any previous voluntary work, skills, qualifications or experience that you consider may be relevant
If you wish to make a Time Bank request, please write the details below
Character Referees
As part of CCVS’s safeguarding we ask all potential volunteers to provide two referees. References can be from a person such as a friend, neighbour, work colleague or support worker but not be from a spouse or partner or an immediate member of your family.
To help us process your application please ensure you have provided all details for each referee as we can only process your application once we have received both of these character references.
1st Referee / 2nd Referee
Name / Name
Address / Address
Home Telephone / Home Telephone
Mobile / Mobile
Email / Email
Once we have received two character references, you will be added to our database receive a Welcome Pack
Emergency Contact
Name / Relationship
Home Telephone / Mobile
Mobility and Transport
Please give details of any disabilities or health problems
NB. (This is to give us an indication of assignments that would be or would not be suitable for you)
Mobility Aids Used (please circle) / None / Wheelchair / Walking Frame / Walking Stick / Crutches / Mobility Scooter / Other (please specify)
Do you hold a current UK driving licence? (please circle) / Yes / No / Do you own your own car? (please circle) / Yes / No
Insurance If you are transporting another Time Bank Member in your car, you should contact your own insurance company and inform them that you are transporting passengers and that you are a volunteer yourself. You will need to be covered for business use (Social Domestic and Pleasure plus Class 1 Business and Commuting). Most insurers do not charge for this extra cover.
Criminal Convictions
The nature of Time Banking is such that you are exempt from the Rehabilitation of Offenders Act 1974, so a police check may be required due to access to vulnerable people. Therefore we encourage you to be open about any criminal convictions you may have in order that we may ensure that we find the right Time Bank assignment for you.
Do you have any criminal convictions/ offences? / Yes / No / Are you willing to have a Disclosure and Barring Service (DBS formally CRB) check? (please circle) / Yes / No
STANDARDS OF CARE
As a member and participant of the Time Bank, I agree to:
1. All exchanges must be carried out through Colchester Time Bank
2. Undertake Time Bank activities alone or with other members and not involve individuals outside of the scheme without the prior consent of the Time Bank. Recognise and discuss with Time Bank any problems or concerns
3. Respect the privacy and confidentiality of other members
4. Respect the views and beliefs of other members
5. Not solicit or accept money, gifts, or tips from other members for assignments
6. Refrain from using any possessions of the member (i.e. the telephone), without consent
7. Respect a no smoking policy in a member’s home or venue of time exchange
8. Always treat fellow members with the same respect
I agree to abide by the above Standards of Care, and confirm that the information given on this form is correct to the best of my knowledge: Data Protection: I consent to the information on this form being held on file in accordance with the Data Protection Act 1998.
Signature / Date

If you have any difficulties or queries when completing this form, please do not hesitate to contact us on 01206 505250

We are always happy to help.

Colchester Community Voluntary Services Winsley’s House, High Street, Colchester, CO1 1UG

Tel: 01206 505250 Email:

“Thriving local communities”

Reg. Charity No: 1092567 VAT No:176515981

CCVS is a Company Limited by Guarantee No: 4426567

Colchester Time Bank Services List

O = Offer R = Request

Account Management / O / R / Children / O / R / Health and Beauty / O / R
Donate Hours / Activity Centre / Beauty treatments
No services posted yet / Support Work / Body Treatments
Negative Hours pot / Toy library / Cosmetics
Unregistered group / Youth work / Facials
Community Pot - Colchester / Community/ Social / Haircare
Art and Crafts and skills / Accompany leisure activity / Health Advice
Arts and Crafts / Activities/ Projects / Manicure / Pedicure
Art Work / Advocacy (public support for a cause)
Craft Work / Befriending
Creating Costumes / Car Washing
Embroidery / Catering / Instruction/ Teaching
Fabric / Conservation / Adult literacy/Numeracy
Furniture Making/painting/restoring / Cooking / Computer skills
Gift Wrapping / Day Trips / Cookery lessons
Knitting / Crochet / Entertainment / Dance
Modelling (Model making) / Escort to appointments / Exercise
Music Instrument Make/ Repair / Family Mentor / Foreign language
Painting and Drawing / Friendship by phone/ visits / Language skills
Photography / Fundraising / Local knowledge
Pottery / Housework / Music tuition
Recycle / Knit and Knatter / Outdoor Activities
Sewing / Laundry / Washing / Ironing / Presentations/ Workshops
Business/Office Services / Library Books- deliver to house bound / Singing lessons
Accounting / Listening / Sport coaching
Administration / Litter Picking / Storytelling and reading
Book Keeping / Nature Reserve / Tutor/ Coaching
Budgeting / Recycle / Pet Care
Bulk Mailing / Sharing Leisure Activities / Animal fostering
Business class / Shopping / Errands / Cats /dogs
Clerical Help / Singing / Dog boarding
Computer Skills / Walks / Dog walking
CV writing / DIY / Other animals
Data Entry / Typing / Decorating / Pet care
Design Work / Furniture / Pet sitting
Facilitate Meetings / Hanging curtains / Time Banking
Form filing / Lifting/Moving furniture / Time Bank Admin
Interpreting / Painting / Time Bank Meeting
Interview skills/ Employment coach / Simple DIY / Time Bank Newsletter
Leafleting / Simple plumbing (e.g. tap washers) / Transportation
Letter Writing / Gardening / Deliveries
Phone Calling / Advice/ Planning/ Design / Driving
Planning / Start up Advice / Gardening / Errands / shopping
Research skills / Hard Landscaping / General transportation
Translations / Lawn Mowing / Giving lifts
Typing / Lifting / Moving plants / Transport Driver
Use of room / Tidying garden / Use of vehicle
Watering plants / Other Services
Weeding

Version June 2015