THE WATERSIDE CENTRE
63 Waterside, Kings Langley, Herts WD4 8HE
Tel: 01923 260092
VOLUNTEER APPLICATION FORM
PERSONAL DETAILS
Surname...... Forenames …......
Address......
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Telephone …...... Mobile …......
Email address………………………………………………………………………………….
PERSONAL STATEMENT
Please outline why you would like to volunteer for us at the Waterside Centre
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Please give details of any special skills, interests, hobbies and anything else you feel you can share with our clients to enhance their experience at The Waterside Centre
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HEALTH
Do you have any health issues that we need to be aware of? Yes...... No …......
(if not please give brief details include any long standing health issues e.g. diabetes, mental health issues )
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Do you consider yourself to have a disability? Yes...... No …......
(if yes, please give brief details)
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BACKGROUND
We are required to check out the background of everyone who has contact with vulnerable adults.
Have you ever been convicted of a criminal offence?
(Declaration subject to the Rehabilitation of Offenders Act)
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Please note that disclosure of an offence or disability does not automatically mean that we will not take you on as a volunteer.
Please provide two references (not family members)
Name …...... Name …......
Address...... Address......
…...... …......
Occupation …...... Occupation …......
Telephone …...... Telephone …......
Email……………………………………… Email…………………………………………
You will also need to apply to the Disclosure and Barring Service for an enhanced DBS Disclosure, you will be given instructions how to do this.
Please give details of next of kin who can be contacted in an emergency:
Name...... Address …......
…......
Telephone No. …...... (home) …...... (mobile)
DECLARATION & AUTHORISATION
I confirm that the information given on this form is, to be best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection.
I authorise The Waterside Centre to obtain references to support this application once an offer has been made and accepted and release the company and referees from any liability caused by giving and receiving information.
Signature …...... Date …......
NOTES:
The information provided is confidential and will not be disclosed to anyone outside of the recruitment process unless required by law. It is subject to the provision of the Data Protection Act 1998
A conditional acceptance of your offer to volunteer with our organisation will be subject to satisfactory adherence to the following conditions -
(1) Two satisfactory references (not members of your family). References will be validated.
(2) A satisfactory enhanced DBS check.
(3) Successful compliance with the Asylum and Immigration Act 1996.
Volunteer Application Form Aug.2016