The Information Provided Will Be Treated As Confidential and Will Be Processed by Our

Befriending and Mentoring

VolunteerApplication

The information provided will be treated as confidential and will be processed by our

Charity strictly in accordance with the provisions of the Data Protection Act 1998

Full name
Mr Miss Ms Mrs Dr Other ______
First Name(s):
Surname:
Date of Birth:
Contact details
Current Address: / Email
Landline:
Mobile:
Employment (if appropriate)
Currently employed by: / Currently employed as:
For students only
Permanent Home Address / Where are you studying?
What course and year?
Previous knowledge and experience
Please tell us if you have any previous knowledge or experience of autism. (This is not an essential requirement as full training is provided). Identify any skills and qualities you have that may be appropriate.
Reasons for Volunteering
Please tell us why you would like to volunteer
In what capacity would you like to volunteer?
 Befriender (2/4 hours per week, minimum commitment to the scheme1 year)
 E-Befriender (regular contact befriending via email only, minimum commitment to the scheme 1 year)
 Mentor (regular visits in order to attain set objectives - minimum commitment to the scheme of 1-year
Safeguarding
The NAS is committed to safeguarding and promoting the welfare of all children and adults who use our services and expects all staff and volunteers’ to share this commitment. If you are selected, you will be required to apply for a Disclosure from the Criminal Records Bureau/Disclosure Scotland/Access NI. As a volunteer in the B&M Department you will come into contact with children and or vulnerable adults and therefore must declare both unspent and spent convictions.
Have you been convicted of any criminal offence or received a police caution or warning Yes/No
If yes, please provide details of the conviction(s) in a sealed envelope and attach it to this application. Having a criminal record will not necessarily be a bar to you volunteering with the NAS.
Are you a UK Passport Holder?Yes/No (If No) Have you been in the UK for 10 yrs or more? Yes/No
If the answer is No to both of the above questions, it will be necessary for you to obtain a certificate of ‘Good Conduct’ from your Embassy before you will be allowed to carry out any volunteering duties with the NAS
References
The NAS requires3 references for all volunteers. The 2 Professional References must include your most recent employer (if possible);a teacher/lecturer from your school/college/university or a professional that you have had dealings with such as an accountant, doctor, lawyer, church minister. A Personal/Character referee must be anon-family member who has known you for a minimum of two years. The NAS follows safer recruitment best practice and therefore requires all volunteers to provide satisfactory references, if a volunteer is unable to provide these they will not be allowed to volunteer for the society.
Professional Reference / Professional Reference / Personal/Character Reference
(Must have known you for more than 2 years – not a family member)
Name:
Title: / Name:
Title: / Name:
Title:
Address:
Post code: / Address:
Post code: / Address:
Post code:
day:
mobile:
fax:
email: / day:
mobile:
fax:
email: / day:
mobile:
fax:
email:
In what capacity does this person know you? / In what capacity does this person know you? / In what capacity does this person know you?
How long have they known you? / How long have they known you? / How long have they known you?
Other Relevant Information
Are you willing to have your photograph taken whilst you are volunteering and used by the NAS for the following purposes? (Delete where appropriate):
Volunteer ID card Yes/No Vol presentationsYes/No To demonstrate service to funders Yes/No
NAS Marketing Yes/No By family/individual whilst volunteering (boundaries to be set) Yes/No
It would be helpful, for future volunteer recruitment, if you could tell us where you heard about volunteering with the NAS.
NAS website / College/University / Media/Press
Community Vol Centre / Word of Mouth / Posters & Leaflets
Mailshot / Other (give details)
Declaration
I confirm that the information I have supplied in this form is correct to the best of my knowledge and that I wish to apply to become a volunteer with the National Autistic Society. I understand that wrongful completion or failure to disclose information where asked will invalidate my application.
Signed: ______Date: ______

Please return to: Befriending & Mentoring Co-ordinator (Trafford Scheme)

The National Autistic Society, Anglo House, Chapel Road, Northenden, Manchester M22 4JN.

0161 998 7860 or 07920 727444 

The National Autistic Society

Confidential Equal Opportunities Monitoring Form

“Committed to Equal Opportunities”

The information will be treated as confidential and used solely for monitoring purposes to assist The National Autistic Society in seeking to be an Equal Opportunities Employer.

______

PERSONAL DETAILS

Surname ______First Name______

Post applied for: VOLUNTEER BEFRIENDER

How did you find out about this role? Please specify source/publication ______

ASYLUM & IMMIGRATION ACT 1996

YESNO

Do you need a work permit? (Please tick or mark with ‘X’)

If yes, do you have a current valid work permit? (Please tick  or mark with ‘X’)

ETHNIC ORIGIN

How would you describe your racial/cultural origin? (Please mark with ‘X’)

 Black - AfricanWHITE

Black – CaribbeanChinese

Black - OtherMixed – white and Black African

Asian BangladeshiMixed – White and Black Caribbean

Asian – IndianMixed – White and Black Asian

Asian – PakistaniMixed - Other

Asian – OtherOther

GENDER

FEMALEMALE

DATE OF BIRTH______

DISCRIMINATION ACT 1995

Do you consider yourself to have a disability? (Please tick or mark ‘X’)YESNO



If you consider yourself to have a disability, we would be grateful if you would indicate its nature and also any adjustments to the workplace that would assist you both at interview and in the role.

Where more than one disability applies, please tick of mark ‘X’ all that apply. Space is provided for you to give further information should you wish to do so.

NATURE OF DISABILITY

AutismAsperger Syndrome

Learning DifficultiesPhysical Coordination Impairment

Other Mental HealthHearing Impairment

Vision ImpairmentSpeech Impairment

Mobility ImpairmentPhysical Disability

Progressive ConditionOther / Unknown Disability

Further Information (optional):

Adjustments needed:

At Interview:
In the workplace:

Please note that this information will be treated confidentially and will not be disclosed to those responsible for short listing.

This information will be used for the purposes of assisting in setting up an interview or making adjustments to the workplace if applicable. There may be occasions when the information is used for monitoring and statistical purposes. In such cases, names and other unique identifiers will be excluded.