Availability How Many Sessions Would You Like to Give?

Saint Michael’s

Fundraising Team Volunteer Interest Form

Where would you like to volunteer? Ripon Shop
Bilton Shop Starbeck Shop

Cold Bath Rd Shop, ‘The Emporium’ Driving/ Stock Deliveries

Cold Bath Road Furniture Shop EBay

Furniture warehouse Street & Store collector

Jennyfields Shop Events Steward

Knaresborough Shop Fundraising local group

Leeds Road Shop Administration
For retail-would you like to specialise in an area? / Ceramics
Clothing
PAT testing
Jewellery / Electricals
Books
Music
Other

Mr/Mrs/Miss/Ms/Other

Surname: / Forename:
Date of birth:
Address:
Postcode: / E-mail address:
Mobile telephone:
Home telephone:

Availability How many sessions would you like to give?

Please tick to indicate when you are most likely to be available to volunteer.
Please give as many alternatives as possible. (Actual duties can be different periods.)
Mon / Tues / Weds / Thurs / Fri / Sat / Sun / Occasional / Occasional
9.15 to 1.00
1.00-5.00

Why would you like to volunteer for the Saint Michael’s Fundraising Team?

Do you have any relevant experience?
To help us allocate you safe and appropriate roles; please tell us of any:

Activity you may find difficult for health or other reasons?
Other information we may need to ensure your safety e.g. hearing or vision difficulties, ability to communicate or understand instructions

Referees: Please supply the names, address and telephone number (Not relations)
Name:
Email address:
Address:
Telephone: / Name:
Email Address:
Address:
Telephone:
How did you hear about volunteering with our organisation?
May we send you emails from time to time regarding Saint Michael’s activities?
Emergency Contact Details:
Who should we contact about you in an emergency? / Name
Telephone
Mobile telephone

I confirm that the information on this form is true and correct.
I agree to be enrolled as a volunteer and to abide by the rules
concerning volunteers, and the policies and procedures of the Hospice
In accordance with the Data Protection Act 1998 I give permission for this personal information to be stored and processed for the purposes of employment and monitoring and for sensitive data to be stored and processed in connection with equal opportunities, health and safety reasons and compliance with the requirements of national standards.
Please note that it is the policy of Saint Michael's that if new volunteers have been recently bereaved we prefer them to wait 6 months before becoming a volunteer
Signed: Date:

Declaration of Criminal Record

As an organisation committed to equality and diversity, Saint Michael’s recognise the contribution that all people can make as volunteers and so we welcome enquiries of interest from everyone. We recognise too that some potential volunteers have criminal records and are reluctant to apply for voluntary work where this would involve the disclosure of their record. We understand that people are often ashamed and embarrassed about their cautions and convictions and/or fear they will not be treated fairly because of them.

Please rest assured that we will handle any information provided below in confidence. Should you disclose them, we will not take into account convictions deemed spent under the Rehabilitation of Offenders Act, unless the voluntary position is exempt from the Act.

Some of our volunteer positions are exempt from the Rehabilitation of Offenders Act. As such, we will ask for disclosure of both spent and unspent convictions, and also cautions, reprimands, and final warnings. For these few volunteer positions we will also ask you to agree to a Disclosure and Barring Service check. If the DBS check reveals information that we were not previously aware of, we will discuss the matter with you before making a final decision. Whilst it is unlikely that a Criminal Record would prevent you from volunteering, we consider each case on an individual basis.

If you require further information about your rights in relation to Disclosure applications, and our responsibilities to you, please ask us for a copy of the Disclosure Code of Practice.

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police?

Yes  No 

If yes, please give details of offences, penalties and dates:

Are you aware of any police enquires undertaken following allegations made against you, which may have a bearing on your suitability for this post?

Yes  No 

If yes, please give details:

Signed: Date:

Thank you for completing this form, we will be in touch!

Equal Opportunities Monitoring Form

Saint Michael’s aims to provide equal opportunities and fair treatment for every individual involved in the organisation. The information below is anonymous and will not be stored with any identifying information about you. All details are held in accordance with the Data Protection Act 1998.

We would like you to complete this form in order to increase our understanding of who we are reaching and to better serve our community. We are committed to having a volunteer workforce that fully represents the diversity of the community we serve. The information you provide will be used to provide an overall profile analysis of our volunteer base.

If you would like the form in an alternative format or would like help in completing the form, please contact the Fundraising Volunteer Coordinator on 01423 879687.

Ethnic origin

How would you describe your ethnic origin?

White Mixed Heritage

British  Irish  White and Asian

Welsh  English  White and Black Caribbean

Scottish White and Black African

Any Other White Background  Any Other Mixed Background

AsianBlack

Indian Caribbean

Pakistani African

Bangladeshi Any Other Black Background

Any Other Asian Background

East Asian

Chinese South Korean

JapaneseNorth Korean

IndonesianThai

Any Other Ethnic Background (please specify)

 Do not wish to declare my Ethnic origin

The Disability Discrimination Act 1995 (DDA) defines a person as disabled if they have a physical or mental impairment which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) adverse effect on one’s ability to carry out normal day-to-day activities. This definition includes conditions such as cancer, HIV, mental illness and learning disabilities.

Do you consider yourself to have a disability according to the above definition?

Yes No Do not wish to declare

Age

16-25  26-35  36-45  46-55  56-65  65-75  Over 75 

Gender Male Female 

Transgender: F to MM to F Prefer not to say

Sexual orientation

BisexualGay man LesbianHeterosexual

OtherPrefer not to say

What is your religion or belief?

Christian  (Please specify denomination):Church of England

Roman Catholic 

Methodist

Baptist

URC Other 

Jewish Buddhist Muslim Hindu Sikh 

None Prefer not to say Other (Please Specify) 

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