King S Volunteersapplication Form King S College Hospital, Denmark Hill

PRIVATE & CONFIDENTIAL

King’s VolunteersApplication Form – King’s College Hospital, Denmark Hill

Many thanks for your interest in volunteering. This form helps us to understand a little more about you and what you could bring to King's Volunteers. We use this information to shortlist applicants, who will then be invited to a Recruitment Event, the next stage in the recruitment selection process. Please complete all sections, as the application won't be processed unless you do so. If you need help filling in the form, contact the volunteering team at King's on 0203 299 5510.

PERSONAL DETAILS

Name (inc title)

Address

Postcode

Telephone.Mobile

E-mail

Date of Birth National Insurance Number

Please provide the details of someone we can contact in the unlikely event of an accident or illness while volunteering

Name Relationship to you

Address

Telephone Email

Your eligibility to volunteer

If you are from the EU, you are free to volunteer in the UK. For those from outside the EU, you will need to check that your visa allows you to volunteer. We advise that you contact the UK Borders Agency to find out.

Your availability to volunteer

Are you able to volunteer for 3 hours each week? Yes ☐No ☐

Please tick the days and times that you would be available to volunteer on a regular basis:

Morning

Afternoon

Evening

Monday

☐

Tuesday

☐

Wednesday

☐

Thursday

☐

Friday

☐

Saturday

☐

/
Sunday / ☐ / ☐ / ☐ /

What can you bring?

There are a wide variety of skills and experiences that we value and we do not expect you to have a particular training. It is useful, however, for us to understand about what you would bring to our volunteer programme.

Please tell us why you want to volunteer and what you hope to gain from the experience
Please highlight what skills, knowledge and/or experience you will bring the role
Can you tell us your understanding of what volunteering in a hospital environment would be like?
Is there any other information you would like us to know that would support your application to volunteer?
Is there a particular role/area of the hospital that you would like to volunteer in?
Access requirements / health conditions

If you have any particular access requirements or health conditions (eg medication or allergies etc) that we should be aware of please state. This is so we can better support you in your role and consider any appropriate adjustments that need to be made to the volunteer environment.

REFERENCES

Please give details of 2 referees who have known you for at least 3 years and who are able to comment on your suitability as a volunteer. Suitable referees include: present or past employers, college tutors, someone from a community organisation, other voluntary agencies you have supported. Members of your family are not acceptable. If you have difficulties finding suitable referees, please contact us.

Name
Address

Postcode
Telephone
Email / Name
Address

Postcode
Telephone
Email
REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER 1975

Because of the nature of the work, all posts in the NHS are exempt from the provisions of Section 4(2) of the Act. Having a conviction will not necessarily prevent you being considered from being a volunteer. Any information you give will be completely confidential, and any failure to disclose convictions will result in your application not being taken forward.

Have you any convictions? Yes ☐No ☐

MEMBERSHIP OF THE TRUST

King’s has a membership made up of local people, patients, volunteers and staff. Being a Member gives you more say in how your local hospital is run. As a Member you will receive @King's magazine, get up-to-date information from King’s and King’s Health Partners, find out about our services, medical breakthroughs, new developments and projects. You will be invited to Members' talks where you will get the opportunity hear about health issues, different illnesses and conditions and how to prevent and treat them as well as the latest research developments. Volunteers are automatically enrolled as Members. Your details will be held securely by the Trust’s Membership Office and you will only be contacted about issues relating to your membership of the Trust. Please tick the box below if you do not wish to be a Member.

I do not wish to become a member ☐

DECLARATION

I understand that any voluntary role offered to me is subject to clearance. I certify that the information I have given is correct and understand that any misleading statements or deliberate omissions could result in my application not being processed and me being asked to leave my role.

I also understand my details will be kept in accordance with the Data Protection Act and will be treated in a secure and confidential manner.

Signature Date

RETURNING YOUR APPLICATION FORM

Email:

Post: Volunteer Services, King’s College Hospital, Denmark Hill,London SE5 9RS

STRICTLY CONFIDENTIAL – EQUAL OPPORTUNITIES MONITORING

You do not have to complete this part of the form but if you would like to do so, the information would be very helpful to us. The information will only be used to provide us with statistics to show us where we need to target our volunteer recruitment. This will help us to make sure that King’s College Hospital NHS Foundation Trust welcomesvolunteers from all areas of our community and that our volunteer base reflects the communities we serve.

Gender

Male☐Female☐I do not wish to disclose this information ☐

In which age group are you?

16-24☐25-34☐35-44☐

45-54 ☐55-64☐65-74☐

75-84☐85+ ☐

How would you describe your religion or belief?

Christian☐Buddhist ☐Jewish☐

Muslim☐Sikh☐Any other religion ☐

None ☐Prefer not to say ☐

What do you consider to be your ethnic background? (Please choose one)

White☐Indian☐Chinese☐

Black Caribbean☐Pakistani☐Mixed Background ☐

Black African☐Bangladeshi☐Other ☐

Disability

Do you consider yourself to have a disability?Yes☐No☐

I do not wish to disclose this information ☐

1v3King’s Volunteers KCHApril 2016