APPLICATION FOR VOLUNTARY WORK

Please complete this form and send it back to the above address. Please delete as applicable where an asterix * is shown. If you need more space for any part of the form please attach a separate sheet.

PERSONAL DETAILS

* Mr / Mrs / Miss / Ms / Full Name
Address
Postcode
Tel. No. - Home / Work:

Please use this space to explain why you are interested in this type of voluntary work

______

______

______

______

______

When are you available to volunteer? (tick as appropriate)

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday
A.M.
P.M.

Please give details of any other voluntary work you have been involved in

______

______

______

______

In order to ensure that volunteers are placed in a supportive volunteering opportunity suitable to their needs, please give details of any learning or physical disability, mental or physical illness, caring responsibilities, transport issues etc. which may affect the type of volunteering work you want to do.

______

______

______

______

How did you hear about the work of Crosby Housing Association's Charity Shop?

REFERENCES

Please give the names and addresses and telephone numbers of two people [one should preferably be a previous or present employer] who will provide a reference. No approach will be made to either person without your permission.

1. / Name
Address
Tel. No.
Relationship to you
2. / Name
Address
Tel. No.
Relationship to you

GENERAL

Have you ever been convicted of, or been cautioned by the police for, a criminal offence [spent convictions as defined by the Rehabilitation of Offenders Act 1974 excluded]?

YES / NO* / If yes, please give details
DECLARATION
The information I have given in this application is to the best of my belief accurate.
Signed______Date ______

Crosby Housing Association is registered under the Data Protection Act. Everything you write on this form will be kept confidential. The personal details held on computer about you can be viewed by written request.

Please your completed form to:

Corporate Resources Officer

Crosby Housing Association

10 Church Road

Waterloo

Liverpool

L22 5NB.

Equality & diversity monitoring

Crosby Housing Associationwants to meet the aims and commitments set out in its equality and diversity policy. This includes not discriminating under the Equality Act 2010, and encouraging equality and diversity.

The organisation needs your help and co-operation to enable it to do this, but filling in this form is voluntary.

Gender Male Female Prefer not to say 

Are you married or in a civil partnership? Yes No  Prefer not to say 

Age16-2425-2930-3435-3940-44 45-4950-54 55-59  60-64  65+  Prefer not to say 

What is your ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box:

White

English  Welsh  Scottish  Northern Irish  Irish 

British  Gypsy or Irish Traveller  Prefer not to say 

Any other white background, please write in:

Mixed/multiple ethnic groups

White and Black Caribbean White and Black African  White and Asian 

Prefer not to say  Any other mixed background, please write in:

Asian/Asian British

Indian  Pakistani  Bangladeshi Chinese  Prefer not to say 

Any other Asian background, please write in:

Black/ African/ Caribbean/ Black British

African  Caribbean Prefer not to say 

Any other Black/African/Caribbean background, please write in:

Other ethnic group

ArabPrefer not to say  Any other ethnic group, please write in:

Do you consider yourself to have a disability or health condition?

Yes No  Prefer not to say 

What is your sexual orientation?

Heterosexual  Gay woman/lesbian  Gay man  Bisexual 

Prefer not to say  If other, please write in:

What is your religion or belief?

No religion or beliefBuddhist  Christian  Hindu  Jewish 

Muslim  Sikh Prefer not to say  If other religion or belief, please write in: