Bradbury House
SERVICE ______12 Shakespeare Street
Nottingham
NG1 4FQ
VOLUNTEER APPLICATION FORM
Jan 2010
Please read carefully the information sheets and instructions before completing the form. Please use black ink as this form may be photocopied. You should complete and return to Age UK Notts, Bradbury House, 12 Shakespeare Street, Nottingham NG1 4FQ.
Name: ______(Mr, Miss, Mrs, Ms) ______
Address: ______
______Post Code ______
Email: ______
Date you moved into your current address: ______
Telephone Number: ______
Do you have your own transport? Yes [ ] No [ ]
Have you volunteered for Age UK Notts or any other Age UK Group previously? If yes, please give details:
______
Have you had previous experience of voluntary work? Yes [ ] No [ ]
If yes please give details:
______
Do you have any skills or hobbies, which may be valuable in the context of voluntary work? (E.g. befriending or counselling skills, computer skills, photography, an interest in writing (prose or poetry) craft skills, first aid, playing a musical instrument, etc.) If so please list:
______
What time of the day/week are you available for voluntary work? Please tick the appropriate box(es).
Day / Morning / Afternoon / EveningMonday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Would you be willing to travel outside of the area where you live to undertake voluntary work?
Yes [ ] No [ ]
Could you be contacted for voluntary work at short notice?
Yes [ ] No [ ] Possibly [ ]
Some areas of voluntary work require the volunteer to receive training in their chosen activity. Would you be prepared to undertake training as required?
Yes [ ] No [ ]
It would be helpful if you could give an indication of the length of time for which you may be available for voluntary work. Please tick the appropriate box.
Up to 3 months [ ] Up to 6 months [ ]
Up to 1 year [ ] For the foreseeable future [ ]
Please provide the names and addresses of two referees (not family members) who would be prepared to give a character reference.
Name: ______Name: ______
Address: ______Address: ______
______
Post Code: ______Post Code: ______
Telephone: ______Telephone: ______
Email: ______Email: ______
Relationship to you: ______Relationship to you: ______
Due to the often sensitive nature of the work undertaken by both staff and volunteers of Age UK Notts and because we often come into contact with vulnerable older people, we must check the criminal records of those that are working with such people.
Please note that having past criminal convictions, cautions or bind overs will not necessarily prevent individuals from volunteering to work with Age UK Notts. Each case will be considered individually. If you would like any further information regarding this, please see the volunteer co-ordinator or the Human Resources Manager who will be happy to help you.
Any information provided will be treated in the strictest confidence.
Please give details of any criminal convictions, cautions or bind overs either spent or unspent:
______
If you have no criminal convictions, cautions or bind overs to declare please tick in the box provided.
I have no criminal convictions, cautions or bind overs: [ ]
In accordance with the Data Protection Act 1998, it is agreed that Age UK Notts may hold and use personal information about me for personnel reasons and to enable Age UK Notts to keep in touch with me.This information can be stored in both manual and computer form.
I confirm that the information on this form and any attachments is correct and complete. I understand that any information later discovered to be incorrect may result in my voluntary post being relinquished.
Signed: ______Date: ______
Please return the completed application form using the envelope provided.
Thank you, we will contact you shortly.