VOLUNTEER APPLICATION FORM

PLEASE COMPLETE AND RETURN THIS FORM WITH
COPY DOCUMENTS (not originals) TO:
Gary Dower, 24/26 Adelaide Park, Belfast BT9 6FX
Tel: 028 9066 9362 Email:
PLEASE NOTE:
THIS IS NOT AN APPLICATION FORM FOR EMPLOYMENT.

Please complete all sections in black ink.

1. Surname (Mr/Mrs/Miss/Ms)
2. Any Previous Surnames
3. Forename(s) underline preferred name
4. Address
Postcode:
E-mail:

5. Home Tel No ______Work Tel No ______

May we contact you at work Yes No
Mobile No ______
When would you be able to volunteer with us? (please tick)
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Morning
Afternoon
Evening
6. Health
Have you had any condition, illness or operation over the last 3 years? Yes / No
Have these resulted in absence from employment? Yes / No
Have you any past or current health problems which could affect
your performance in this position? Yes / No
I am/am not a registered disabled person (delete whichever does not apply)
7. What are your hobbies or interests?
8. What previous work experience, including volunteering do you have?
9. Why would you like to become a volunteer? What are the qualities,
experience, and particular interests that you think you can contribute to
the post?

Signed ______Date ______

Please note: All information received will be dealt with in confidence, consistent with our commitment to Safeguarding Children & Vulnerable Adults.

______

Have you had treatment for any illness during the past five years which may have a bearing on your ability to work with children and young people? / Yes /
No /
If Yes, please specify
Is there any reason that you cannot take up a position in regulated activity (i.e. working regularly in an unsupervised capacity with children, young people or vulnerable adults)? / Yes /
No /
Do you have any convictions that are not ‘protected’ (as defined by the Rehabilitation of Offenders (Exceptions) (Northern Ireland) Order 1979, as amended in 2014)? / Yes /
No /
Signature of Applicant
Please be aware that a criminal record will not necessarily prevent applicants from gaining a position.
The Presbyterian Church in Ireland’s policy on the recruitment of ex-offenders and Access NI’s Code of Practice is available in the ‘Resources’ section of our website.
* This position is eligible for an enhanced disclosure check. By signing this form you give permission to progress with an application that involves the barred list check. It is a criminal offence to apply for an Enhanced Disclosure check if you are on one of the barred lists.
Identity validation (To be completed by Residential & Supported Services Manager)
Three documents should be produced in the name of the applicant; one from Group 1 and two from Group 2. If this is not possible, then four documents from Group 2 should be produced, one of which being a birth certificate issued after the time of birth. At least one of these documents should be photographic identification.
Applicant details as they appear on the ID documentation provided:
Full name: / ……………………………………………………………………….
Date of Birth: / ……………………………………………………………………….
Current Postcode: / ……………………………………………………………………….
I confirm I have seen the original ID documentation as indicated on the attached sheet.
Date of ID check / ……………………………………………………………………….
Signed / ……………………………………………………………………….
Name (Capitals) / ……………………………………………………………………….
GROUP 1 / GROUP 2
 / Current passport (any nationality) /  / Birth certificate (UK, ROI, Isle of Man or Channel Islands) issued after time of birth
 / Biometric Residence Permit (UK) /  / Marriage/Civil Partnership Certificate (UK, Isle of Man or Channel Islands)
 / Current driving licence (UK, ROI, Isle of Man, Channel Islands or any EU country) /  / HM Forces ID card (UK)
 / Original birth certificate (UK, Isle of Man or Channel Islands) issue at time of birth /  / National Insurance Card or notification letter with NI number (UK)
 / Original long form Irish birth certificate –issued at time of registration of birth /  / Firearms licence (UK and Channel Islands)
 / Adoption certificate (UK, Isle of Man or Channel Islands) /  / Bank / Building Society Account Confirmation Letter
*documentation must be less than 3 months old
** documentation must be issued within the last 12 months /  / Electoral ID card (NI only)
 / EU National ID card
 / Cards carrying the PASS Accreditation logo (UK and Channel Islands)
 / Senior SmartPass (Translink) (NI only)
 / Current UK driving licence (old paper version)
 / Examination certificates (16-18 year olds only)
 / Bank/Building Society Statement (UK or EEA)*
 / Credit card statement (UK or EEA)*
 / Utility Bill (UK or ROI)* – not mobile phone
 / Benefit statement (UK)*
 / Addressed payslip*
 / Mortgage statement (UK or EEA)**
 / Financial statement (UK)**
 / P45/60 statement (UK and Channel Islands)**
 / Land and Property Services Agency rates demand (NI only)**
 / Work Permit/Visa (UK) (UK Residence Permit)**.
 / Letter from a Head Teacher or Further Education College Principal (16-18 year olds in full time education – only to be used when other documentation routes are exhausted)**

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