Inspire Project
INSPIRE PROJECT
VOLUNTEER
APPLICATION PACK
Name:Age:
Contact Details
First Name: / Usual Correspondence Address:Postcode:
Surname:
Date of Birth:
Occupation:
Daytime Tel: / Other Correspondence
(if applicable – please specify, e.g. term-time address)
Postcode:
Evening Tel:
Mobile Tel:
E-mail:
Gender: Male / Female / Tel for other correspondence:
Previous Experience & Skills
Please give details of any relevant experience or skills that you have for working with young people:Why do you want to volunteer for FOCUS and what qualities do you feel you will be able to contribute?
Do you have any additional qualifications and skills?
Qualification / Expiry Date
First Aid / Yes / No
Food Hygiene / Yes / No
Driving Licence / Yes / No / If “Yes”, does your licence entitle you to drive a minibus? / Yes / No
Volunteer Selection Procedure
FOCUS takes very seriously its legal duty of care to protect the clients we work with. For this reason, it is our policy to conduct a Disclosure & Barring Service check on all volunteers and to ask for two referees. You will also be asked to attend an interview before undertaking training and joining a FOCUS project.Because our work involves access to young people, FOCUS is exempt from some of the provisions of the Rehabilitation of Offenders Act 1974. You are therefore obliged to disclose to us any previous criminal convictions (whether they are ‘spent’ or ‘unspent’). You will be asked about this at your interview.
Referees
Please provide details of two people who we may contact for a reference. Referees should be people you have met through a professional relationship (or who are in a position of responsibility), who, unless they are a current employer or tutor, must have known you for at least one year. If you have ever worked with young people, one referee should have supervised you in that work.
Name: / Name:
Position: / Position:
Address and Telephone Number: / Address and Telephone Number:
I certify that the details I have provided are correct and I acknowledge that this information may be stored in a database. (Details will not be passed to any other organisation). I agree to a Disclosure & Barring Service check being carried out before I join a FOCUS project as a volunteer.
Signed: ……………………………………………….……. Date: …………………………….
Next of Kin / Emergency Contact / Address:
First Name:
Surname: / Home Phone Number:
Relationship to you: / Mobile:
Email:
Your Doctor / Surgery Address:
Doctor’s Name:
Telephone Number:
Medical Information
Please describe any current health problems: (Attach an additional sheet if necessary.)
Do you suffer from (please circle): / Asthma / YES NO
Epilepsy / YES NO
Other conditions requiring medication / YES NO
If yes, please complete below:
Name of Drug: / Dosage: / Time(s) Taken:
Dietary Requirements (please circle as appropriate):
Do you require:
Vegetarian meals? / YES / NO
Halal meals? / YES / NO
Pork Free meals? / YES / NO
Beef Free meals? / YES / NO
Do you have a dietary intolerance to:
Dairy Products? / YES / NO
Gluten? / YES / NO
E-Numbers? / YES / NO
Any other dietary needs? Please specify:
Allergies
Do you have an allergy to?
Penicillin? / YES / NO
Nuts? / YES / NO
Shellfish? / YES / NO
Bee Stings? / YES / NO
Plasters? / YES / NO
Aspirin? / YES / NO
Any other allergies? Please specify:
Additional Info
Have you ever had a tetanus injection? / YES / NO
Have you had a booster in the last 10 years? / YES / NO
Can you swim? / YES / NO
Any other information we should be made aware of? Please specify:
Disability Needs
Are you disabled? / YES / NO
If ‘Yes’ is there any specific support or assistance you will require? Please specify:
CONSENT
In the event of illness or accident requiring emergency treatment, I authorise a responsible staff member of FOCUS to sign on my behalf any written consent required by the practitioner if the delay arising through trying to obtain my own signature is considered inadvisable by the practitioner concerned.
Signature: ______Date: ______
Print Name: ______