NCBI Volunteer Application Form

NCBI Volunteer Application Form

Thank you for your interest in becoming an NCBI volunteer. Please complete this application form fully and return to NCBI at your convenience. All information contained in this form will be treated as strictly confidential.

In line with best practice in this area NCBI will seek Garda clearance and two character references for all persons before enrolling them as an NCBI volunteer. For our mutual benefit there is a probation period for all volunteers during which time appropriate induction and training will be provided.

Please return completed form to NCBI Volunteer Service, NCBI Head Office, Whitworth Road, Drumcondra, Dublin 9.

Personal Details
Name______
Address______
 Male
 Female
Contact Information
Please indicate the best number for contact by placing a tick next to it.
Home Tel No:______
Work Tel No: ______
Mobile No:______
Email: ______
Age Group
 18 – 25
26 – 40
41 – 55
56 – 69
 70 plus
Are you
In full time employment
Working in the home
Student
In part time employment
Unemployed
Retired
If employed, please state your occupation ______
Emergency Contact
Name of next of kin: ______
Relationship to you:______
Address______
Tel:______
Medical
Do you have any medical condition or illness that might affect your work as a volunteer?
Yes
No
If yes, please give details: ______
Do you have a vision impairment?
Yes
No
Volunteering
What motivated you to volunteer withNCBI? ______
Have you any previous experience of working with people with vision impairment or other disability?
Yes
No
If yes, please give details: ______
What skills, experience, hobbies and interests do you have which you feel might be useful to you as a volunteer? ______
What do you hope to gain from volunteering with NCBI? ______
Volunteer Activities
The following are some of the roles volunteers carry out for NCBI.Please tick the activities that interest you.
Community Based Volunteer (no car)
Assist people who are vision impaired in the community with a specified task such as reading, writing, going for a short walk or offering companionship.
Community Based Volunteer (with car)
Same role as described above but also willing to take person with vision impairment out in your car to local shops, local gardens, seaside, areas of local interest, to social events, etc.
Computer Support Volunteer
Assist people who are vision impaired in the community with computer skills.
Sighted Guide Volunteer
Assist and guide people who are vision impaired on NCBI day trips and outings.
Library Volunteer (Dublin Based)

Assist with checking in and sending out books
Edit books before they are translated into Braille
Record talking books

NCBI Retail Charity Shop Volunteer
Assist in the overall operation of a charity shop in your locality.
How did you hear about volunteer opportunities with NCBI?
Radio
Written Media
Website
Word of Mouth
Other ______
Referees
Please provide us with the names of two referees. These should be individuals (not family) who have known you for at least 2 years and who would be willing to act as referees, for example an employer, someone from a school or college, a community representative, etc.
Name:______
Address:______
Tel:______
Occupation:______
Relationship to you:______
I declare that the information I have given is, to the best of my knowledge, true and accurate and may be checked as required.
Signed:______
Date:______