2.Your Interest and Skills

1.PERSONAL DETAILS

Position(s) applying for(circle/delete as needed)
Reception Lifeguard Pool Assistant Swim Teacher
Maintenance Volunteer / Title: (Mr/Ms/Mrs/Miss/):
Forename(s): / Surname:
Daytime tel no: / Evening tel no:
Mobile tel no: / Email address:
Address: / Preferred means of contact:
Do you need a work permit to work in the UK
Yes/No (please delete as appropriate) / If yes, please give date of expiry:

2.YOUR INTEREST AND SKILLS

Why are you interested in becoming a volunteer with Moseley Road Baths?
Where did you hear about the opportunity?
What are you hoping to gain/achieve by volunteering at Moseley Road Baths?
What strengths and skills could you bring ?
Anything else you would like to tell us in support of your application?

3.TRAINING

Please list any courses which you have undertaken , or are currently doing, relevant to the Moseley Road Baths opportunity

Date / Organising Body / Course Title / Duration of course

4.AVAILABILITY

Approximately how much time would you like to give each week (Weekly commitments are easiest for us to manage but let us know if you can volunteer in a different pattern of time.)

Please indicate particular times below (e.g. 6pm to 9pm)

Mon / Tue / Wed / Thu / Fri / Sat / Sun
Morning
Afternoon
Evening
Any other considerations about the times you are able to volunteer?

5.REFERENCES

Please give details of two referees. Students should give the name of your college tutor. We will not request references without your prior consent and will only contact them if we offer you a voluntary position.

Referee 1 / Referee 2
Name
Position:
Organisation:
Email address:
Tel no:
Relationship to you:

6. DISABILITY

The Disability Discrimination Act defines a person as having a disability if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities. Giving information about your disabilities or health problems ensures that we take appropriate steps to respond to your application in a fair and equal manner. Describing your disability or ongoing health problems will not preclude you from consideration for a volunteer opportunity for which you are able; however this information will assist us in deciding what adaptation (if any) may be required.

Do you have a disability as defined above? YES NO
If yes, please describe the disability
Please describe any adaptations you believe that you may need for this volunteering opportunity
Please state any assistance you may need in order to attend a meeting with us.

7.CRIMINAL CONVICTIONS

Have you any unspent criminal convictions? YES/NO
If yes, please give details

Applicants declaration:

I declare that all the information given in this Volunteer Application Form is correct and if successful, I will notify Moseley Road Baths of any changes when they arise. I also agree to support the mission, aims goals and core principles of Moseley Road Baths. I understand thatfor some opportunities a Disclosure & Barring Service disclosure may be required.

Signature:
Date:

NB: We can accept this form electronically with a printed name for now, with a paper copy supplied when you meet with us.

Please return your completed form to:

If you prefer to post your form please contact us for the address.