PART ONE Personal Details

PART ONE – Personal details

Title / Home Address
First name
Family name
Daytime telephone
Mobile telephone
Email
Do you have the right to work in the UK?(Please note that if you don’t have the right to work in the UK you run the risk of deportation by volunteering)
Do you have any unspent criminal convictions or is there any action pending against you?(This will not necessarily prevent you from volunteering – each case is dealt with under its own merits)
Do you have a disability or specific need for which special arrangements or adjustments are needed for the role?(All information is strictly confidential. If yes, we may contact you in confidence to discuss your requirements)

PART TWO – About you

I am interested in the following volunteer roles:

Community Engagement Volunteer Research Volunteer

Oral History Volunteer

Other (please specify if you would like to help in another way

Background and interests:Please give brief details. This can include your skills and experience you can bring to this role any hobbies, interests, and previous volunteering roles that you think may be relevant.
Why do you want to volunteer and what do you hope to get out of it?

Employment

Employed
(Full time) / Employed
(Part time) / Unemployed / Retired / Student
(Full time) / Student
(Full time)

PART THREE – References (please provide contact details for two people (not related to you) who we can contact to comment on your character and ability to carry out this role.

Title / First name / Family name / Title / First name / Family name
Address / Address
Telephone / Telephone
Email / Email
Relationship to you / Relationship to you

PART 4 - Emergency contact details

Name
Relationship to you
Daytime phone number
Mobile phone number

PART FIVE - Declaration

Please confirm by signing below or by typing “I agree”

Are you aged 18 or over? Yes No If not what age are you? ………………

I declare that the information I have given is, to the best of my knowledge and belief, true and complete.

Signed: / Date:

Please complete and return to:

Email to:

By post to: Beth Thomas, Project Coordinator, Melksham Remembers, Melksham Town Council, Market Place, Melksham, SN12 6ES

All information will be held securely and in line with the Data Protection Act 1998.

| Twitter: @MelkshamRemem | Facebook: MelkshamRemembers