Please Note the Main Hospice Is Only Open on Weekdays

Volunteer Application Form

Name: / Click here to enter text. /
Volunteer role(s) you are interested in: / Click here to enter text. /

Section 1 – Personal Details

Title / Choose an item. / Surname / Click here to enter text. /
Forename(s) / Click here to enter text. /
Telephone / Click here to enter text. / Mobile / Click here to enter text. /
Email / Click here to enter text. /
Address Line 1 / Click here to enter text. /
Address Line 2 / Click here to enter text. /
Town / Click here to enter text. /
County / Click here to enter text. /
Postcode / Click here to enter text. /
Emergency Contact Name / Click here to enter text. /
Emergency Contact Telephone / Click here to enter text. /
Relationship to You / Click here to enter text. /
What age group do you fall into? For insurance purposes you must be over 14 (16 for clinical roles). We also need to inform our insurance company of volunteers over 75. / 14-15 / ☐ /
16-17 / ☐ /
18-74 / ☐ /
75+ / ☐ /
Date of Birth
(for insurance
purposes only) / Click here to enter a date. /
If you are under 18, please ask your parent/guardian to sign the consent form on page 6.
Please tick if you would like to receive information about our fundraising & and other events:
By Post ☐By Email ☐

Section 2 – Reasons for Volunteering

Please tell us why you would like to volunteer for Nottinghamshire Hospice.
Click here to enter text. /
What knowledge and skills are you able to bring to the hospice? Please cite any relevant work experience.
Click here to enter text. /
When are you available to volunteer on a regular basis (if applicable)?
(Please tick
as appropriate) / Mon / Tue / Wed / Thurs / Fri / Sat / Sun
am / pm / am / pm / am / pm / am / pm / am / pm / am / pm / am / pm
☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ /
Any other comments about your availability?
Click here to enter text. /

Please note the main hospice is only open on weekdays.

Shops are open from Monday-Saturday (West Bridgford is also open on a Sunday)

Events can happen at various times

Section 3 – DBS / Induction

DBS (Disclosure and Barring Service)
Some volunteers will be working with vulnerable adults or members of the public, and will be subject to a criminal record check from the Disclosure and Barring Service (DBS). Nottinghamshire Hospice will cover the cost of this.
Under the rehabilitation of Offenders Act 1974, do you have any unspent criminal convictions? Yes☐ No☐
If you have ticked yes, details of the conviction will be discussed at interview if relevant. Having a conviction will not necessarily stop you from volunteering. Careful consideration is given to providing opportunities for ex-offenders to develop their work and skills.
Induction
All Volunteers will be required to attend a one day welcome induction at the Hospice which will cover the mandatory training requirements in order for you to volunteer with us.
An invitation letter will be sent out to you prior to your start date.
Attendance at the induction and manual handling training is mandatory for all volunteers. Please tick to confirm that you have read this and agree to attend a session within the first three months of volunteering ☐
Where did you hear about us?
☐ / Do-it.org
☐ / Volunteer Centre (please specify) / Click here to enter text. /
☐ / I know a patient helped by the hospice
☐ / Word of mouth
☐ / Social Media
☐ / Website
☐ / Through College
☐ / Poster
☐ / Other (please specify) / Click here to enter text. /
If you are currently studying at school, college or university please tell us where:
Click here to enter text.
Please note that Nottinghamshire Hospice operate a strict no-smoking policy at all sites and in vehicles used for hospice purposes.

Section 4 - References

Please give the names and addresses of 2 people who can act as referees. They will be asked to comment on your suitability for the volunteering role you have chosen.

Both referees musthave known you for at least 2 yearsand be aged over 18. Referees can be your previous manager, a tutor, landlord, support worker or another hospice volunteer.

If you are applying to volunteer as a counsellor or complementary therapist, one of your referees must be able to comment on your ability in these areas (e.g. supervisor, tutor, line manager). Applicants under 16 only require one referee, preferably from a teacher.

References cannot be family members or people that you live with.

Referee 1

Title / Choose an item. / Name / Click here to enter text. /
Address Line 1 / Click here to enter text. /
Address Line 2 / Click here to enter text. /
Town / Click here to enter text. /
County / Click here to enter text. / Postcode / Click here to enter text. /
Telephone No / Click here to enter text. / Email / Click here to enter text. /
How do you know this person? / Click here to enter text. /

Referee 2

I declare that the information provided is true.(Please note: If returning this form electronically, your typed name will be accepted as a signature)

Signed: / Click here to enter text. / Date: / Click here to enter a date. /

Section 5 - Parental/Guardian Consent

If volunteer is under 18, this form needs to be completed by a parent/guardian

I (full name of parent/guardian)

Click here to enter text. /

of (address)

Click here to enter text. /

give consent for (name of child)

Click here to enter text. /

to volunteer with Nottinghamshire Hospice and to travel between locations with a member of staff if necessary.

Signed: / Click here to enter text. / Date: / Click here to enter a date. /

Section 6 -Recruitment Monitoring Form

This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained purely for monitoring purposes.

Application for the post of: / Click here to enter text. /
Gender / Male / Female
☐ / ☐ /
Do you consider yourself to have a disability? / Yes / No
☐ / ☐ /

What is your ethnic group?

Choose ONE section from A to E, and then tick the appropriate box to indicate your cultural background.

A: White
☐ / White UK
☐ / Irish
☐ / White non-UK
☐ / Any other white background (please give details): Click here to enter text.
B: Mixed
☐ / White & Black Caribbean
☐ / White & Black African
☐ / White & Asian
☐ / Any other mixed background (please give details): Click here to enter text.
C: Asian or Asian British
☐ / Indian
☐ / Pakistani
☐ / Bangladeshi
☐ / Any other Asian background (please give details):Click here to enter text.
D: Black or Black British
☐ / Black Caribbean
☐ / Black African
☐ / Any other black background (please give details):Click here to enter text.
E: Chinese or any other ethnic group
☐ / Chinese
☐ / Any other ethnic background (please give details):Click here to enter text.
F: I do not wish to provide this information ☐