Please attach photograph /
CONFIDENTIAL Application to volunteer with Chain of Hope

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PERSONAL DETAILS
Surname/family name:
First/given names:
Title:
Address:
Postcode:
Contact details
Telephone:
Mobile:
E-mail address:
Do you hold a British Passport?
If no, please state:
Do you need a work permit?  Yes  No
If you have a visa entitling you to be in the UK please state the type of visa you hold:

MEMBERSHIP OF PROFESSIONAL BODIES

Name of Body / Registration or Membership Details / First Registration / Registration Number / Renewal Date

FURTHER PROFESSIONAL QUALIFICATIONS

Name of Awarding Body/Institution / Name of Award/Title of Course / Year Obtained
BLS/PALS Training
Date of last BLS update
If PALS/EPLS trained, type and date of course
OTHER RELEVANT EDUCATION & TRAINING
Secondary/Further or Higher Education
Name of school/college/University or awarding body / Level of Qualification / Subject / Grade / Year Obtained
Languages
Do you speak any languages other than English?
If so at what level of fluency?
CURRENT POST
Employer’s name and address / Post held and in type of ward/unit / From To / Reason for leaving (if applicable)
PREVIOUS EXPERIENCE
(Over the last 10 years - please ensure you account for any gaps. Or submit CV)
Dates
from/to / Name, address and nature of organisation / Your role/title / Reason for leaving/finishing
INFORMATION SUPPORTING YOUR APPLICATION
Please give any additional information which you think would be relevant to your application.
REFERENCES
Please give two people who are able to provide references relating to your work experience and suitability for this post. One should be from your current manager who must be at band 7 or above. Friends or colleagues who are not your direct line manager are not suitable.
Name: / Organisation:
Address and postcode:
Telephone Number: / E-mail:
Relationship to you:
Name: / Organisation:
Address and postcode:
Telephone Number: / E-mail:
Relationship to you:

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