‘Si senior’

(over 50’s international

exchange programme)

APPLICATION FOR VOLUNTEER ROLE

We welcome applications from all sections of the community and from people with diverse experience and backgrounds.

PERSONAL DETAILS

Post Applied for : ______

Name:______

Address:______

______Postcode: ______

Contact Number(s): ______

Email address: ______

Do you have any support needs that we should be aware of? ______

______

Why do you want to volunteer?
The points below are the skills and abilities required.
Next to each point please give us examples of how your skills/abilities and previous experience would support you to carry out the volunteer role.
An interest involunteering and basic knowledge of the voluntary sector
Customer service skills
Effective working within a team
Flexibility and willingness to learn
Good comuincation skills and a willingness to learn basic Spanish
Basic ICT skills
Ability to organise self and workload
Experience of or willingness to try new experiences and embrace different cultures
Prepared to travel internationally (this must include having a current valid passport and being fit to travel
To be out of the country and away for home for a period of 3 weeks
Commited to volunteering time for whole programme March –june
Ability to access the appropriate level of travel insurance

References

Please give the names and address of two referees (for example, a friend of the family, work colleague, teacher or voluntary work organiser. They cannot be a relative.)

Name 1) / Name 2)
Address / Address
Post Code / Post Code
Telephone Number / Telephone Number
Email Address / Email Address
Relationship to You / Relationship to You

How did you hear about this voluntary opportunity?

Signature:…………………………………...... Date: ………………………………………….
Data Protection Act 1998
Your personal information will be held by BVSC, and will only be used to contact you regarding volunteering. Some of your personal information (for example age, gender, postcode) may be required by our funders. We will also use it for monitoring and evaluation to make sure we provide a fair service.
By signing this form, you are consenting to us holding this information, and using it as detailed above.
PREVIOUS CONVICTIONS
Have you been convicted of a criminal offence (other than “spent” convictions under the Rehabilitation of Offenders Act 1974 (amended).
Yes  No 
If yes, please give details.
If your application is in respect of a position, which involves the supervision of, or is otherwise connected with occupations that are exempt from the Rehabilitation of Offenders Act 1974 (amended) you are required to declare any convictions for criminal offences. You may provide details here or submit them on a separate sheet in a sealed envelope, marked “Confidential”.

Equal Opportunities Monitoring

Birmingham Voluntary Service Council is committed to equal opportunities. To make sure that that volunteers are selected and treated on the basis of their individual merits and abilities, it would help us if you would provide the information requested below. We are also required to monitor this information under the Equalities Act 2010, and for our funders.

The information below is anonymous and will not be stored with any identifying information about you. All details are held in accordance with the Data Protection Act 1998.

ETHNICITY

Please state what you consider your ethnic origin to be.

White

 English/Welsh/Scottish/Northern Irish/British Irish

 Gypsy or Irish Traveller Other (please write below)

______

Black/Black British

 African Caribbean Other (please write below)

______

Asian/Asian British

 Indian Pakistani Bangladeshi  Chinese

 Other (please write below)

______

Other ethnic group

 Arab Other (please write below)

______

Mixed/Multiple Ethnic Groups

 White & Black Caribbean  White & Black African White & Asian

 Asian & Black Other (please write below)

______

 Rather Not Say

Disability

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

 Rather Not Say

Orientation

 Heterosexual Gay Lesbian Bisexual

 Rather Not Say

Gender Identity

MaleFemaleTransgenderF to M

M to F

Intersex person

 Rather Not Say

Faith

 Christian (including Church ofEngland, Catholic, Protestant and all other Christian denominations)

 Buddhist Sikh Hindu Jewish Muslim

 No religion  Rather Not Say

 Other (please write below)

______

Age

 16-19 20-29-30-34 35-39 40-44 45-49

 50-54 55-59 60-64 65-70 70+

 Rather Not Say

Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR

Tel: 0121 678 8839 Email: