Volunteers Registration Pack.

NAME:

Please complete this document and return it to:

or to the office at:

People in Action

3rd Floor

Symons House

Belgrave Street

Leeds LS2 8DD

If you need help filling out this document please get in touch:

0113 2443729

For office use only

Date reference sent / Date reference rec’d / DBS
1. / 1. / Date completed:
Date checked
2. / 2.

Volunteering Application Form

/ Name
D.O.B.
/ Address
/ Tel No
/ Mobile
/ Email
What is your preferred method of contact?
Please give details of any disability or medical condition you feel we should know about…
Have you any particular interests or hobbies (past or present) which could be shared with somebody?
Have you worked as a volunteer before? (please give details)

Emergency contact

Name
Relationship
Tele no
Mobile

Where did you hear about People in Action?

………………………………………………………………. ( please specify)

When are you available to volunteer?

Daytime Evenings

Weekdays Weekends

(Mon-Fri) (Sat – Sun)

Other (please say)

Do you have a full, clean driving license?

Yes No

Do you have transport available?

Yes No

Own vehicle: Yes No

Public Transport: Yes No

References

Please give the names of two referees, for example: employer, tutor, long-standing friend (not a relative).

People In Action works with vulnerable people and we always take up references.

Reference 1

Name
Address
Tel No
Email
Relationship to you

Reference 2

Name
Address
Tel No
Email
Relationship to you

We have to check with the Criminal Records Bureau for any record of criminal convictions, which may affect your application. In order to do this we need the following information:

Date of birth
Name (if you were previously known by another name).
Date
Signature
(under 18s please get your parent/guardian to sign for you)

Photography consent form

People In Action may take photographs or record videos of its projects or events. This material may be used to promote the work of People In Action through press and publicity materials, for example Newsletters, Leaflets and the People In Action website.

Please indicate as to whether you DO or DO NOT permit to the careful use of your photograph in any of the following:

/ Leaflet: / I DO give permission
I DO NOT give permission
/ Website: / I DO give permission
I DO NOT give permission
/ Newsletter: / I DO give permission
I DO NOT give permission
Name
Date
Signature

Volunteer’s Agreement

People In Action are mindful that people’s circumstances may alter over time and so any commitment made to volunteering may have to change.

However, as People In Action tries to avoid letting people down, we would ask you to ensure that you can keep to any commitment you make to volunteering as far as possible. If any change has to be made, please try to give as much notice as you can.

I have read and understood People In Action’s Volunteers’ Policy and agree to the requirements for volunteering with People In Action.

I agree to undertake training in, and work in accordance with, People In Action’s policies.

I will inform People In Action if I wish to change, or end, my arrangements for Volunteering.

Please register me as a People In Action Volunteer.

Volunteer’s Signature
Name
Date

Equal opportunities form

Inline with our equal opportunities policy, People In Action would like you to answer the following questions. Filling in the form is optional. This form is only used for monitoring to make sure that our procedures are as fair as possible.

Gender:

Male Female

Do you have a disability?

Yes No

Age group:

0 - 11 / 12 - 20 / 21 - 30 / 31 - 40 / 41 - 50 / 51 - 60 / 61 -70 / 70 +

Ethnic origin:

White
British / European / Other – give details
Mixed
White and Black Caribbean / White and Black African / White and Asian
Other – give details
Asian or Asian British
Indian / Pakistani / Bangladeshi
Other – give details
Black or Black British
Caribbean / African / Other – give details
Other ethnic groups – give details