Volunteer Application Form

Thank you for your interest in volunteering with RISE.

Before completing this form, please refer to the RISE website: If you have any questions or need any support in completing this form, please contact the Volunteer and Peer Mentor Coordination Teamusing the details below.

You can complete this form by using Microsoft Word and emailing it back to us, or by typing it out in Word, and then printing it out for posting.Alternatively you print this out, and write it by handfor posting, if you do please ensure you write in block capitals.

Volunteer and Peer Mentor Coordinator:Carrera-Leigh DixEmail:

Telephone:020 5678 4772Post: Carrera-Leigh Dix, RISE, 103 Broadway, West Ealing W13 9BP

Personal Details
Title / Surname / FirstName
StreetAddress
Town/City / Postcode
Telephone / Mobile
Are you 18 or older? / Email
In order to comply with recent amendments to the Immigration, Asylum and Nationality Act 2006 all candidates of non-EU countries are required to have a work permit to take up unpaid voluntary work in the UK. If applicable, do you have permission to do voluntary work?
About You
Why would you like to volunteer with Ealing RISE?
Which role are you applying for?
What skills or experience do you think you could bring to this role? Please include any professional experience you have.
When are you available to volunteer (days/times) and how often? Refer to the role description for the availabilityrequested.
Are you capable of interpreting or translating another language? If ‘Yes’, please state which languages.
Please give details of any support needs you have. Feel free to contact the Volunteer Coordinator to discuss them.
Referees
As we work with vulnerable adults we need to carefully screen all of our volunteers. Please provide the names and contact details of two referees, unless the role description specifically only asks for one. At least one, and preferably both of your referees, should know you in a professional capacity (for example, employer/line manager, volunteer manager, university/college tutor). Neither referee should be a direct family member. If you are unsure about who to put forward as your referees, please contact the Volunteer and Peer Mentor Coordinator who will be happy to offer guidance.
Referee 1
First Name / Surname
Address
Including postcode / How do you know this person?
How long have you known this person?
Email / Telephone
Referee 2
First Name / Surname
Address
Including postcode / How do you know this person?
How long have you known this person?
Email / Telephone
Is it ok for us to request references on receipt of the application form? / Yes No
Criminal Record Check
Certain volunteering roles will require a criminal record check (DBS). If the role you are applying for requires this, we will ask you at interview stage to make a written declaration of any unspent criminal convictions, cautions, reprimands or warnings. Having a criminal record will not necessarily prevent you from volunteering with us.
Emergency Contact Details
Please fill in these details so in the event of an accident or emergency, Ealing RISE can notify the appropriate person.
Emergency Contact Name
Emergency Contact Number
Relationship of this person to you
Declaration
In accordance with the Data Protection Act 1998, the information provided on this form will be used in the recruitment and selection of volunteers and may be disclosed to all those who need to see it. It will also form the basis of the confidential volunteer record.
I confirm that any information given is correct. / Signed / Date

Equal Opportunities Form

RISE is committed to equality of opportunity in every aspect of its work. The data collected from this form helps RISE to monitor the success of its Equality and Diversity policy. Please note this form is completely anonymous and all information is confidential.
Please answer each of the following criteria by marking which category best describes you.
Gender: / Male / Female / Do you consider yourself to have a disability? / Yes / No
Age range: / 18 -24 / 25 – 34 / 35 – 44 / 45 -54 / 55 -64 / 65 +
Employment Status: / Student / Employed / Self-employed / Unemployed / Retired
How would you describe your ethnicity? / Black or Black British
African
Caribbean
Any other black background / White
British
Irish
Any other White background
Asian or Asian British
Bangladeshi
Indian
Pakistani
Any other Asian background / Mixed
White & Asian
White & Black African
White & Black Caribbean
Any other mixed background / Other Ethnic group
Chinese
Any other ethnic group
I do not wish to disclose my ethnic group
Please indicate your religion or belief.
Atheism / Buddhism / Christianity
Islam / Sikhism / Other:
Judaism / Hinduism / I do not wish to disclose my religion/belief
Please indicate your sexuality.
Lesbian / Bisexual / Other:
Gay / Heterosexual / I do not wish to disclose my sexuality.
How did you hear about volunteering at Ealing RISE?
CRI/ RISE Website / Word of mouth / Current volunteer/employee
Volunteer Centre / Charityjob website / Do-it Website
University/College / Other: