Application for Volunteering Position

Date of application:
Private and Confidential
Return this form to: Zoe White/Nadine Fitzsimmons, South Somerset Mind, Unit 4, Yeovil Small Business Centre, Houndstone Business Park, Yeovil, Somerset, BA22 8WA.
Volunteer Role Applied for:
OR
Area of Interest: Office Skills Workshop Fundraising Support Work
Gardening Project Other:______
Name:
Address:
Postcode:
Tel:
Email:
Emergency contact number:
Name:
Relationship:
Please note here your leisure interests, sports and hobbies, or other pastimes, etc

Previous Experience: Please provide any work/volunteering that is relevant to the role you are applying for. (Please start with your most recent experience)

Name of organisation / Role and duties
References
Please provide details of two referees who can provide information relating to your competency to perform in a volunteering role. If you are a student please give an academic referee.
1. / Name / 2. / Name
Position / Position
Organisation / Organisation
Address
Postcode / Address
Postcode
Tel No / Tel No
Please detail here your reason for this application
Where did you hear about us?
Special Requirements
Do you require any assistance in order to fulfil a volunteering role e.g. – hearing loop, help with reading or writing, access to buildings etc.
Please specify
Disclosure Barring Service
If the nature of the volunteering for which you are applying is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.
In addition you may be required to submit to a Disclosure and Barring Service check. Any standard or enhanced disclosure made by the DBS will remain strictly confidential.
Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence YES/NO (delete as required)
If YES, please give details
Please use this space below to tell us how often you are able to volunteer and what your availability is.
Special Requirements (Care Sector)
If this position involves the care of children and/or vulnerable adults a volunteering position is dependent on the following:
1) Your written consent to obtaining a standard/enhanced disclosure certificate from the Disclosure Barring Service or an approved umbrella body.
2) Such disclosure being acceptable to us.
3) Proof of identity- birth or marriage certificate/civil partnership (where appropriate) and passport (if available).
4) Two satisfactory written references.
5) Evidence of physical or mental suitability for your work if requested.
DECLARATION (Please read this carefully before signing this application)
1. I confirm that the above information is complete and correct and that any untrue or
misleading information will give South Somerset Mind the right to terminate any
volunteering position offered
2.. I agree that should I be successful in this application, I will, if required, apply to the
Disclosure and Barring Service for a basic disclosure. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of South Somerset Mind
Any offer of volunteering may be withdrawn or terminated.
Signed ...... Date ......

Equal Opportunities Monitoring Form

STRICTLY CONFIDENTIAL

We aim to be an equal opportunities employer and we select staff and volunteers only on merit irrespective of age, disability, ethnicity, religious faith or belief, gender, sexual orientation, transgender status etc.

We request all applicants provide the information indicated for monitoring the effectiveness of our Equal Opportunities Policy only.

This information will not be used as part of the selection process.

  1. Age Group:

Under 18  18-24  25-44  45-59  60+ 

Prefer not to say 

  1. Gender:

Female  Male  Prefer not to say 

  1. Gender Identity:

Is your gender identity the same as the gender you were assigned at birth?

Yes  No  Prefer not to say 

  1. Disability:

Disabled Non-disabledPrefer not to say 

  1. Ethnicity:

White: British  Irish  Other 

Black or Black British: African  Caribbean  Other 

Asian or Asian British: Indian  Bangladeshi  Pakistani 

Other 

Mixed / Dual Heritage: White & Black Caribbean

White & Black African 

White & Asian  White & Any Other 

Other ethnic group:

Chinese 

Romany Gypsy

Irish Traveller 

Any other 

Prefer not to say 

  1. Nationality:

British  European Union  Non-European Union  Prefer not to say 

  1. Religious faith or belief:

None

Buddhist

Christian

(including Church of England, Catholic, Protestant and all other Christian denominations)

Hindu

Jewish

Muslim

Sikh

Other

Prefer not to say

  1. Sexual Orientation:

Heterosexual / straight Gay / Lesbian BisexualOther

Prefer not to say 

  1. Status:

Married / In a Civil Partnership (CP)

Living with partner 

Single

Divorced / Dissolved CP 

Separated 

Prefer not to say 

  1. How did you find out about us?

…………………………………………………………………………………

…………………………………………………………………………………

Please return to South Somerset Mind

Thank you.

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