Application Form for Volunteer Bereavement Supporter

Surname / Title
Forenames / Date of Birth
Preferred Name / Telephone
Address / Mobile
Postcode

** PLEASE NOTE **

STARS is committed to a policy of Safeguarding Children and Safer Recruitment. All applications are dependent on a successful interview, satisfactory CRB checks and carries a commitment to mandatory safeguarding training , any appropriate bereavement/ children’s work training and the completion of a satisfactory probationary period.

EDUCATION, TRAINING & QUALIFICATIONS
Please give details of relevant education, training & qualifications.
Please feel free to continue on a separate sheet if necessary
Dates / Awarding /Training Body / Qualification
Are you a car owner? / YES/NO / Do you hold a valid British Driving Licence? / YES/NO
HEALTH INFORMATION
Do you have any current health issues that might affect you work as a Bereavement Support Practitioner?YES/NO
If YES please state:
Are you a registered disabled person? YES/NO
If YES please give details:
Please feel free to continue on a separate sheet if necessary
WORKEXPERIENCE
Please give details of your work experience, starting with the most recent.
Please ensure you include work experience with children and young people.
EXPERIENCE
1Please give details of any additional experience working voluntarily with children and young people.
Please make clear whether this includes1:1 or group work.
2.Please give details of any previous counselling/supportingexperience.
3.Please give details of any other life experience that you feel would be relevant.
What attracted you to STARS?
Please give reasons why you wish to work at STARS with bereaved children & young people.
Please give details of major losses that you have experiencedand please describe ways in which you have been able to deal with them(eg redundancy, retirement, divorce, major illness, death of family member/friend).
(Please note this post is not suitable for someone currently grieving or with unresolved grief issues)
PLEASE GIVE DETAILS OF YOUR CURRENT COMMITMENTS (family, work, other voluntary/community work).
Please continue on a separate sheet of paper if necessary

Rehabilitation of offenders act 1974

Posts at STARS are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act by virtue of the Rehabilitation of Offenders Act( Exemptions) Order 1975. You must declare all convictions you may have had. Please provide information on a separate sheet. Any information given will be confidential and will not necessarily disqualify you application to become a volunteer supporter.

Do you have any criminal convictions? YES/NO

If YES please provide details as above.

REFERENCES:
Please give the names and addresses of 2 people that we could contact for a reference.
  • These should be people who know you well, but are not relatives and can comment on your suitability to become a Bereavement Volunteer and your ability to work with children.
  • If you are a counsellor or trainee counsellor one of these should be your supervisor or course tutor.

1st Referee / 2nd Referee
Name / Name
Address / Address
Postcode / Postcode
Contact telephone number / Contact telephone number
Email / Email
DECLARATION
I understand that any opportunity to work as a volunteer support with STARS is subject to a
successful interview and selection process, satisfactory CRB clearance, willingness to sign a formal contract of employment, including a commitment to mandatory Safeguarding Children training and the successful completion of a 6 month probationary period.
I hereby declare that the above information is correct.
SIGNATURE:DATE:

Please return your completed form to Ann-Marie McKiernan at:

Or via post at the STARS address given on page 1.