Occupation (Or Past Occupation If Retired)

About You

Title:

First name:

Surname:

Address:

Postcode:

Home Tel:

Mobile Tel:

Email:

Date of Birth:

Occupation (or past occupation if retired):

Have you had any serious illnesses or injuries, or do you have any allergies or other conditions of which we should be aware?

Yes No

If yes, please provide details:

Emergency contact number and name, while you’re volunteering with DJH:

Name:

Tel. No:

Relationship:

Skills and experience

Please give details of any previous volunteering

either with YHA or elsewhere:

Please tell us why you would like to volunteer with YHA / DJH?

Do you have a full driving licence?

Yes No

Have you had any endorsements in the last

3 years?

Yes No

If yes, please give details:

Please give details of any relevant skills, experience

and qualifications that will enable you to fulfil the

above role(s)?

How did you hear about volunteering for YHA/DJH?

Family/friends YHA/DJH-Publications

YHA/DJH Website At a Youth Hostel

Other (detail below)

References

Please give the names of two referees, one of whom should be your present or most recent employer, where applicable. Alternatively, referees must be people who you know in a professional capacity such as employers, doctors, teachers / college lecturers. We will not accept references from friends, neighbours or family.

Referee 1

Name:

Address:

Occupation:

Postcode:

Telephone:

Email:

Referee 2

Name:

Address:

Occupation:

Postcode:

Telephone:

Email:

Criminal offences

Do you have any criminal prosecutions pending

(excluding minor motoring offences e.g. speeding)?

Have you ever been convicted of any criminal

offences which are not yet spent under The

Rehabilitation of Offenders Act 1974 or The

Rehabilitation of Offenders(NI) Order 1978. Spent

convictions need not be declared. (Please note

that any ex-offenders of such convictions will be

considered on an individual basis and the nature

and potential relevance of the offence to the job

being applied for will be taken into account in the

recruitment decision)

Yes No

If yes, please give details:

This role requires a Criminal Records Bureau

Check, therefore you will also need to complete the Declaration Form

Declaration

I consent to checks being made with relevant parties and declare that the information that has been given in this form is correct to the best of my knowledge.

Signed:

Date:

If you are under 18 this form must be signed by

parent/guardian.

Signed:

Data protection

DJH will use the information you have provided to

process your application as a volunteer. If you are

successful in your application, we will inform you of your placement details and the training and support available.

Please return to:

YHA Volunteering,

Trevelyan House,

Dimple Road,

Matlock, Derbyshire

DE4 3YH

Web: